A PPO (Preferred Provider Organization) is a list of health care providers who have agreed to negotiated discounts for services and are considered "in-network" for certain plans.

Use of PPO providers is strongly encouraged but not mandatory. Charges from a non-PPO provider will be paid at a lower benefit level and will not apply to the annual out-of-pocket maximum.

Do the dental plans have PPO lists?

Yes, both dental plans use the Cigna Dental PPO Network. Cigna PPO dentists will file your claims for you and have accepted lower negotiated rates. Payment is always based on the negotiated rates. So if you use a non-PPO dentist, he or she may charge more than the negotiated rate, and you will have to pay the difference.

What does reasonable & customary (R&C) mean? How does it affect me?

Reasonable & customary charges are determined by independent organizations, and are used by insurance companies nationwide to calculate and regulate benefit payments. The R&C charges are determined based on the type of procedure and the geographic area. Non-PPO providers may charge you more than the R&C charge, and you may be required to pay the difference.

Do I need to pre-certify my treatment?

For medical services, pre-certification is needed for an in-patient hospital admission (including maternity), in-patient treatment at a skilled nursing facility or rehab hospital, non-emergency ambulance, or transplant services. Pre-certification for emergency admission to the hospital must be done within 72 hours. The pre-certification phone number is 1-800-244-6224 and is on your medical plan ID card.

For mental health or substance-related services, all services must be pre-certified through ValueOptions by calling 1-866-665-6305, regardless of whether you wish to use an in-network or out-of-network provider.

If pre-certification requirements are not followed, claims will not be eligible for payment.