Dental Care DHMO (K1-09) Plan

USI Affinity CIGNA Dental Care^® DHMO Plan offers IBOs many advantages, including access to our:

• Nationwide network of dental providers
• Dental office locator (available 24 hours a day/7 days at week) by calling our member services at 1-800-CIGNA24 (1-800-244-6224).
• Easy to read “Patient Charge Schedule (K1-09)” that outlines your dental plan benefits, including covered procedures and your out-of-pocket charges per service.

Download a copy of the CIGNA Dental Care DHMO Patient Charge Schedule (K1-09).

Our USI Affinity CIGNA Dental Care DHMO Plan is also easy to use. There are no deductibles, no claim forms, and no annual or lifetime dollar maximums.

Your Monthly Premiums

IBO only $40.37
IBO plus spouse $71.78
IBO plus dependent children* $80.18
IBO, spouse, and dependent children* $126.68

The above rates are valid until December 31, 2024.

*Dependent Children Eligibility: any unmarried child of yours who is less than 26 years old. Dependent children eligibility and age limits may vary by state – refer to the CIGNA insurance certificate for specific state variations. This rate applies to all eligible dependent children regardless of the number of children covered under your plan.

Eligibility for Enrollment

You are eligible to enroll in our CIGNA Dental Care DMHO Plan if you are a current IBO and a member of the Independent Business Owners Benefits Association (IBOBA) or spouse and/or dependent child, a U.S. citizen living in the United States and hold a social security number, you may enroll.

Once you are enrolled under this CIGNA group plan, should your coverage terminate for any reason, you (and your eligible spouse and/or dependent children) will have to satisfy a 12-month waiting period to re-enroll.

Specialty Care

Specialty care services are included at the same fees listed on the attached Patient Charge Schedule at the network specialist office, with a referral approved for payment by CIGNA Dental.

Emergencies

You will be reimbursed (up to $50.00, less applicable patient charges) if you experience an emergency while away from home. Please contact CIGNA’s Member Services at 1-800-CIGNA24 (1-800-244-6224) for information on how to handle emergencies. If an emergency occurs after office hours, please refer to the attached Patient Charge Schedule.

Second Opinions

Second opinions are considered a standard covered feature of the CIGNA Dental DHMO Plan. Please contact CIGNA 1-800-CIGNA24 (1-800-244-6224) to assist you in scheduling an appointment.

Locating a CIGNA Dental Provider

We made it easy and convenient for you to see if your dental provider is in the CIGNA network, or to locate a CIGNA dental provider within the network near you. You may contact CIGNA’s 24-hour telephonic dental office locator at 1-800-CIGNA24 (1-800-244-6224) and select option #1. This automated system is updated daily, so you are provided with the most current information.

You may visit the CIGNA website to see if your dental provider is in the CIGNA network or to access the entire CIGNA network of dental providers.

Please note: If you select a dental provider outside of the CIGNA network, you will be responsible for all fees the dentist charges. We encourage you to take advantage of the many benefits in choosing a dental provider within the CIGNA dental network.

Nominate your dental provider to be part of the CIGNA network.

Please note: IBOs have a choice of two DHMO plans. Our DHMO Plan (K1-09) and our DHMO Value Plan (WAO09). Please review the attached comparison chart to see the differences between the two plans. The differences in the two plans are the charges shown in the Patient Charge Schedules and Alternate Benefit Provision which applies to the DHMO Value Plan (WAO09).

You may contact one of our customer service professionals during our regular business hours (8:00 a.m. to 5:00 p.m. EST) at 1-800-254-2327, or email us with your questions. We can answer any questions or provide you with assistance regarding your benefits, network dental providers, or claims.

Please note: USI Affinity is not an insurance company. Insurance plans and services are provided by insurance companies and other licensed insurance-related providers. USI Affinity represents these insurance companies and is paid a commission and may also receive other performance-based compensation for the services provided to you.

Download a copy of the enrollment instructions and IBO CIGNA Dental DHMO Enrollment Form.

Please note: This is not a certificate of insurance. This page highlights the coverage of dental benefits available through CIGNA Dental and does not include all exclusions and limitations.

Benefits are underwritten or administered by CIGNA Health and Life Insurance Company. This information is intended as a summary of benefits only. It does not describe all the terms, provisions and limitations of your plan. A complete description of the terms of coverage, exclusions and limitations, including benefits, will be provided in the insurance certificate. In case of discrepancy between this brochure and the plan documents, the plan documents will prevail. Services started prior to your plan becoming effective may not be covered.

IBOBA: When you register or renew as an IBO, you also become a member of the Independent Business Owners Benefits Association (IBOBA). The IBOBA is a non-profit association which promotes the interests of its members at the local, state and federal government levels, to use the power of group buying to make available to the members benefits and services such as travel programs, including automobile rental and hotel discounts, insurance, non-insurance healthcare discounts, and to provide educational information and forums. This insurance is just one benefit arranged through the IBOBA.