City of Knoxville - Dental Plan

DENTAL PLAN

For more information please call Risk Management at 215-2111.

The City offers a base dental plan to all benefits-eligible employees at no cost, which includes an annual exam, cleaning and set of bite-wing x-rays. You may purchase additional coverage for yourself and your eligible family members. If you elect additional dental coverage, you should choose a dentist in that network to perform your base exam. If you don't, you may be responsible for up to the full cost of the visit.

Choose from:

A dental PPO, provided through Delta Dental

A traditional dental option, provided through Delta Dental

A dental HMO (DHMO), provided through CIGNA

Dental PPO and Traditional Option

If you elect the PPO or traditional option, you can see any provider you choose. However, if you use a dentist in Delta Dental's PPO or Premier networks, you will not be billed for charges exceeding the maximum plan allowance. See the chart and footnotes below, or visit http://knoxville.deltadentaltn.com. Use this website also to locate network providers.

In addition, both options cover additional exams/cleanings (up to four per year) for diabetics and pregnant women with periodontal disease, individuals with renal failure or suppressed immune systems, head and neck radiation patients, and individuals at risk for infective endocarditis.

DHMO

If you choose the DHMO, you must use a CIGNA network dentist to receive benefits. Visit www.cigna.com (if notenrolled) or www.mycigna.com (if enrolled).

Dental Options at a glance:

	Delta Dental PPO (1)	Delta Dental Traditional (1)	CIGNA DHMO (Must use an HMO dentist to receive coverage)
YOU PAY
Annual deductible	$50/individual $150/family	$50/individual $150/family	$0
THEN THE PLAN PAYS
Preventive care (exams, x-rays, cleanings)	100% no deductible	100% no deductible	100% (2)
Basic care (fillings)	80% after deductible	100% after deductible	See charge schedule
Major care (crowns, dentures, bridges)	50% after deductible	50% after deductible if covered for past 12 months	See charge schedule
Orthodontia	50% no deductible (children to age 19 only)	50% no deductible (adults and children)	See charge schedule (adults and children)
Annual benefit maximum (3)	$1,500	$1,500	N/A
Orthodontia lifetime maximum	$1,500	$1,500	N/A

(1) Providers in Delta Dental's PPO and Premier networks have agreed not to exceed the maximum plan allowance (MPA). If you use a provider outside these networks, you're responsible for charges exceeding the MPA.
(2) The CIGNA DHMO covers up to four annual cleanings (two at 100% coverage; two at a low scheduled cost). See the charge schedule for details.
(3) Once covered charges (excluding orthodontia) reach the annual benefit maximum, no further benefits are payable for the remainder of the plan year.