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Summary Plan Description (SPD)
Emergencies - Reimbursement
An emergency is a dental problem that causes
acute pain or requires immediate treatment.
- Emergency Care Away From Home - If an emergency arises while Covered Person is more than 50 miles away from home or unable to contact his or her Network General Dentist, covered services performed by any general dentist for diagnosis and relief of pain shall be reimbursed by CIGNA Dental Health up to a total of $50 per incident, less applicable Patient Charges. This reimbursement shall be made after Covered Person submits appropriate reports and X-rays to CIGNA Dental Health.
- Emergency Care After Hours - The Patient Charge Schedule lists a Patient Charge for emergency care rendered after regularly scheduled office hours. This charge shall be in addition to other applicable Patient Charges.