Introduction
We offer dental coverage through the Marathon Petroleum Dental Plan (the Dental Plan), administered by Cigna. Under the plan, you can receive care from any licensed dentist; however you will save money when you visit a dentist in the Cigna Dental Preferred Provider Organization (DPPO) network, since these dentists have agreed to give plan members the largest discounts. Out-of-network dentists who participate in the Dental Network Savings Program (DNSP) have also agreed to offer discounts to Dental Plan members.
Dental Plan Information for Active Employees
When you visit a network dentist, the plan pays all or a portion of the negotiated cost of the service. When you visit an out-of-network dentist, the plan pays all or a portion of the Reasonable and Customary (R&C) charge*.
| Cigna Dental PPO |
| Annual Deductible: $50 per person |
| Calendar Year Maximum (not including orthodontia): $2,000 per person |
| Service Type |
Service Examples |
Plan Pays |
| Preventive and Diagnostic |
Exams (limited to two per year), x-rays, fluoride treatments |
100% (no deductible) |
| Basic |
Fillings, extractions, root canals |
80% (after deductible) |
| Major |
Inlays, crowns, dentures |
50% (after deductible) |
| Orthodontia (lifetime maximum: $2,000) |
|
50% (after deductible) |
*R&C is determined by the average usual charge for a given procedure charged by most dentists in a given geographic area.
Dental Plan Information for Pre-65 Retirees
Retirees under age 65 are eligible for dental coverage that is similar to the coverage provided to MPC active employees. The individual calendar year maximum is different for pre-65 retirees, and so are the contribution amounts for coverage. For information on monthly contributions for COBRA coverage under the active dental plan, see COBRA Rates.
Under this Plan, you can receive care from any licensed dentist. However, you can save more when you receive care from a dentist in the Cigna Dental Preferred Provider Organization (DPPO) Advantage Network, since these dentists have agreed to give Plan members the largest discounts.
| Pre-65 Retiree Dental Plan – 2017 Monthly Contributions |
| Retiree Only |
Retiree + Spouse |
Retiree + Children |
Retiree + Family |
| $23 |
$46 |
$50 |
$79 |
| Pre-65 Retiree Dental Plan Coverage |
| |
Cigna Dental PPO |
| Calendar Year Maximum (Individual) |
$1,000 |
|
Calendar Year Deductible
- Individual Maximum
- Family Maximum
|
|
|
Preventive and Diagnostic Care:
- Oral Exams
- Cleanings
- Routine and Non-Routine X-Rays
- Fluoride Application
- Sealants
- Space Maintainers (limited to non-orthodontic treatments)
- Emergency Care to Relieve Pain
|
Plan covers 100% (no deductible) |
|
Basic Restorative Care:
- Fillings
- Oral Surgery
- Surgical Extraction of Impacted Teeth
- Anesthetics
- Major and Minor Periodontics
- Root Canal Therapy/Endodontics
- Relines, Rebases and Adjustments
- Repairs: Bridges, Crowns and Inlays
- Repairs: Dentures
|
You pay 20% after deductible is met |
|
Major Restorative Care:
- Crowns/Inlays/Onlays
- Dentures
- Bridges
|
You pay 50% after deductible is met |
| Orthodontic Care |
Not covered |
| Claims |
ID cards are not issued for the Pre-65 Retiree Dental Plan. You or your provider files a claim form for reimbursement. |