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Local 153 Clerical

Fordham University DHMO Dental Plan Booklet

2020 Dental Benefits for Local 153

For complete descriptions of your benefit options, as well as an explanation of how to make your 2020 choices, please see the 2020 Enrollment Guide for Local 153.

We offer a stand-alone dental plan that is not a part of the medical plan option you choose.

DHMO

DHMO Benefit Summary

 

In-Network

Out-of-Network

Annual Deductible

None

Plan does not provide out-of-network benefits

Preventive and Diagnostic Care

No cost to you for preventive/diagnostic care and basic fillings. You share the cost of other services based on Cigna’s Dental Patient Charge Schedule

Plan does not provide out-of-network benefits

Basic Restorative Care

No cost to you for preventive/diagnostic care and basic fillings. You share the cost of other services based on Cigna’s Dental Patient Charge Schedule

Plan does not provide out-of-network benefits

Major Restorative Care

No cost to you for preventive/diagnostic care and basic fillings. You share the cost of other services based on Cigna’s Dental Patient Charge Schedule

Plan does not provide out-of-network benefits

Orthodontia

No cost to you for preventive/diagnostic care and basic fillings. You share the cost of other services based on Cigna’s Dental Patient Charge Schedule

Plan does not provide out-of-network benefits

Calendar Year Maximum

No maximum plan benefit

No maximum plan benefit