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ABC Board Parrott <br /> Prepared for: County of Orange � <br /> r Benefit Group <br /> Prepared by: Michele Moffitt, 336-249-7705 <br /> Effective Date: 1/1/2026 <br /> CIGNA CIGNA <br /> Deductible $25/$75 $25/$75 <br /> excludes Preventive care <br /> Annual Maximum Benefit $1,750 $1,750 <br /> Orthodontia Lifetime Benefit $1000 per child $1000 per child <br /> Preventive Care 100%Coverage 100%Coverage <br /> Oral Exams 1 per 6 months 1 per 6 months <br /> Full Mouth X-rays 1 per 60 months 1 per 60 months <br /> Cleanings 1 per 6 months 1 per 6 months <br /> Fluoride Applications 1 per 12 months-to age 19 1 per 12 months-to age 19 <br /> Sealants 1 per 36 months-to age 19 1 per 36 months-to age 19 <br /> Basic Restorative Care 80%Coverage 80%Coverage <br /> Endodontics <br /> Periodontics <br /> Extractions <br /> Fillings <br /> Major Restorative Care 50%Coverage 50%Coverage <br /> Crowns/Inlays/On I ays <br /> Bridges <br /> Dentures <br /> Implants <br /> Orthodontia 50%up to age 19 50%up to age 19 <br /> TOTAL COST <br /> Employee 35 $4233 $44.26 <br /> Employee+Spouse 3 $86.91 $90.88 <br /> Employee+Child(ren) 2 $96.71 $101.13 <br /> Family 1 1 $151.34 1 $158.25 <br /> TotalTotal Monthly Premium $2,129.37 $2,226.51 <br /> Total Annual Premium $25,552.44 $26,718.12 <br /> Percent Change <br /> ***THIS IS ONLY A SUMMARY OF THE PLAN PROVISIONS. THE POLICY LANGUAGE WILL PREVAIL*** <br />