Tailored Dental TOB
Dental Care
Annual Deductible
On all treatment, per insured member or dependant Nil
Class One
Investigative and Preventative Treatment.
Benefits include:
• Routine check-ups, where no pain or issues are experienced and no further Treatment is anticipated prior to visit.
• Examinations, x-rays, scale & polish.
Class Two
Basic Restorative Treatment, Periodontal Treatment and Treatment of Dental Injury.
Benefits include:
• Root canal Treatment, extractions, surgical procedures, occasional Treatment, anaesthetics, periodontal Treatment.
Class Three
Major Restorative.
Benefits include:
• Dentures - acrylic/synthetic, metal and metal/acrylic;
• Crowns, inlays, mouthguard or occlusal splint.
• Implants
Orthodontic Treatment
Orthodontic Treatment for Dependant children under the age of 18.
Notes:
100% up to €300 per year of insurance
85% up to €3,000 per year of insurance
85% up to €3,000 per year of insurance
85% up to €1,000 per year of insurance
1. Examinations and Scale and Polish will both be limited to 2 visits per Year of Insurance.
2. Full case assessment will be limited to one per Year of Insurance.
3. X-rays will be limited to four Bitewings and six Intra Oral per Year of Insurance and OPG every 3 years.
4. Prolonged periodontal Treatment limit of one course per year of insurance.
Exclusions
In addition to the Exclusions specified in the Exclusions section of the policy Terms and Conditions, Cigna will not pay Benefit for the following Treatment and extras in relation to the Cigna dental cover:
a. Benefit is not payable for Treatment which: is purely Cosmetic; or is not necessary for continued Oral Health
b. Benefit is not payable for the following procedures, services or Items:
• replacing any dental appliance which is lost or stolen;
• replacing a bridge, crown or denture which is or can be made useable according to a standard acceptable to a Dentist of ordinary competence and skill in the country where Treatment is incurred;
• replacing a bridge, crown or denture within five (5) years of original fitting unless:
o the replacement is needed because of the placement of an original opposing full denture or extraction of natural teeth is needed; or
o the bridge, crown or denture, while in the mouth, has been damaged beyond repair because of an Injury the Employee or their Dependant receives while covered under the Plan.
• porcelain or acrylic veneers on the upper and lower first, second and third molars and premolars;
• crowns or pontics on or replacing the upper and lower first, second and third molars unless:
o they are constructed of either porcelain bonded-to-metal or metal alone, e.g., gold alloy crown;
o or temporary crown or pontic is required as part of routine or Emergency dental Treatment.
• procedures and materials which are experimental or which do not meet accepted dental standards;
• instruction for plaque control, oral hygiene and diet;
• procedures, services and supplies which are deemed by Cigna to be medical procedures, services and supplies including mouthwashes and also including services and supplies provided in a hospital (except where dental Treatment is neither wholly nor partly the reason for the stay in hospital);
• orthodontic Treatment for Employees and/or Dependants who are over the age of eighteen (18) (Orthodontic Treatment will only be paid for Dependent children who are under the age of eighteen (18). In this case, the Employee or Dependant must send the following information prepared by the Dentist who is to carry out the proposed Treatment to Cigna before Treatment starts, so that Cigna can confirm how much Benefit will be payable (Benefit will be payable only if Cigna has confirmed cover before Treatment starts):
o a full description of the proposed Treatment;
o X-rays and study models;
o an estimate of the cost of the Treatment)
• bite registration, precision or semi-precision attachments;
• procedures, appliances or restorations (except full dentures) whose main purpose is to:
o change vertical dimensions; or
o diagnose or treat conditions or dysfunction of the temporomandibular joint; or
o stabilise periodontally involved teeth; or
o restore occlusion.
• major Treatment on Deciduous or baby teeth for Dependant children.
Annual Deductible
On all treatment, per insured member or dependant €20
One eye examination per Year of Insurance by an Optometrist or an Ophthalmologist. Paid in Full
Expenses for:
• lenses to correct vision;
• eyeglass frames;
• prescription sunglasses.
Expenses For:
• corrective eye surgery, including:
• laser eye surgery
75% up to €600 Per Year of Insurance
This benefit requires prior approval Up to €4,000 per year of insurance
Exclusions
In addition to the Exclusions specified in the Exclusions Section of the Policy Terms and Conditions, Cigna will not pay Benefit for the following Treatment and extras in relation to the Cigna vision cover:
• payment for more than one eye examination in any one Year of Insurance
• sunglasses, unless medically prescribed
• lenses which are not a Medical Necessity and are not prescribed by an optometrist or ophthalmologist or frames for such lenses.