Cigna Copays, Deductibles, and Coinsurance Definitions
Dental insurance is a great benefit that many people choose to purchase as a means to care for their oral health. Cigna dental plans offer a wide range of benefits but there are some industry terms that can make choosing the right plan for you a little confusing. Here, we will review the meaning of the terms copay, deductible, and coinsurance to help you better understand the plan options available with Cigna.
What is a copay?
A co-pay is a fee that is paid to your dental provider at the time of your visit, typically before you are seen. Not all plans use a co-pay to share in the cost of covered services but some use both co-pays and a deductible. You may also experience some visits that do not have a copay at all. Your copay is a predetermined rate based on your plan and is usually printed on the front of your insurance card. The co-pay covers a portion of the cost of your visit.
What is a deductible?
The deductible varies plan to plan and is the amount that the member pays out-of-pocket before insurance benefits take effect. For example, if your yearly deductible is $1000, any treatment that you receive at your dental office up to that thousand dollar mark is your responsibility. After you have met your deductible, your dental insurance will begin to pay a portion of each billed service.
Most plans have a premium and a deductible, one being higher, which brings the other down. If you do not have a history of dental issues, you may benefit from a higher deductible with a lower monthly premium. Additionally, if you have a history of oral problems, a higher monthly premium with a lower deductible might be the better option.
Your deductible will typically be lower if you take advantage of in-network providers.
What is coinsurance?
After you have met your deductible, coinsurance kicks in and a percentage of your treatment cost is paid by your Cigna insurance. When you are shopping for your dental plan, the coinsurance percentages will be laid out for you. For example, a coinsurance of 80/20 means that Cigna will pay 80% of the cost of treatment and you are responsible for the remaining 20%.
In-network providers have a contracted amount that they can bill for services. Out-of-network providers have their own fee schedule and will end up costing the member more out-of-pocket.
Most Cigna dental insurance plans have a maximum benefit amount that is paid each year. This total ranges between about $1000 and $3000 and means that after you meet your deductible, Cigna will pay up to the established benefit amount each year. Most plans cover preventative treatment in full, but if you have additional services after you have reached your maximum benefit for the year, you will be responsible for the cost of that treatment.
Be sure to take the time to research all available plans to ensure that you choose the best fit for you and your family.
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