Your Benefits

The City offers you the opportunity to enroll in one of two dental plans. Below are highlights of each plan to help you choose one that best meets your needs. See your Schedule of Benefits at the bottom of the chart for complete benefit details.

Plan Comparision

	SGX185 Dental HMO	CitiDent Dental PPO
How the Plan Works	When you enroll in the DHMO plan, you will pre-select a primary care dentist from the network to provide your day-to-day care. Except for Emergency Dental Services, out-of-network benefits are not available through the DMHO. Each enrolled family member may select a different participating dentist and has the ability to change dentists up to one time each month.	When you enroll in the PPO plan, you may choose to see any dentist in-network or out-of-network. Out-of-pocket expenses may be higher when using an out-of-network dentist.
Specialty Care	These plans feature “Direct Referral”. Your selected participating dentist will provide you with the name of a network specialist. Just call that specialist to schedule your visit. No pre-authorization is required**. Any co-payment amount for specialty services is listed on your plan’s Schedule of Benefits.	You do not need a referral for specialty care. Just select a dentist and make an appointment.
Calendar Year Deductible	None	$50 per person $150 per family
Calendar Year Maximum	None	$1,200
Co-payments & Co-insurance	Co-payments are set by procedure and all covered procedures are listed on the Schedule of Benefits	Preventive: 100% Basic: 80% Major: 50% Non-surgical TMJ: 50% after deductible, $500 lifetime maximum per person
Orthodontic Services (Braces)	Co-payments by type of service - $1695 for comprehensive treatment (adult & child available)	$1500 Lifetime Maximum, no Deductible (ages 6-19)
Waiting Period	None	None
Complete Benefit Details	DHMO Schedule of Benefits DHMO Evidence of Coverage	DPPO Schedule of Benefits

Enrollment Tips

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Enrolling in the Dental HMO Plan — SGX185

You have only one opportunity each year to change plans and that’s at open enrollment. Important tips to remember:

Review the DHMO Schedule of Benefits and Evidence of Coverage before making your decision. They have important information that will help you get the most from your dental benefits. If, after reviewing the plan documents you have any questions, our Customer Service Representatives will be happy to assist you.
Remember to select a general dentist from the participating dentist directory for you and each of your enrolling family members.
Write the Facility Number in the space allotted on your enrollment form.

Enrolling in the Dental PPO Plan — CitiDent

You have only one opportunity each year to change plans and that’s at open enrollment. Important tips to remember:

There is no need to "pre-select" a dentist when you enroll.
When choosing a dentist, remember that if you choose to receive care from a participating dentist, you could save on your out-of-pocket costs. Participating dentists have agreed to accept their negotiated fee as payment in full with no balance billing.
Your DPPO Schedule of Benefits includes the information on how payment is calculated for your plan and is included above along with the plan Exclusions & Limitations. A copy of the Certificate of Insurance is also available below for your review.