Healthy teeth and gums are important to your overall health. That’s why it’s important to have regular dental checkups and maintain good oral hygiene.
Here’s a brief overview of dental plan benefits. For details, please refer to the summary plan description or contact Cigna.
In-Network Member Pays | Out-of-Network Member Pays* | |
---|---|---|
Calendar-Year Deductible – Individual | $50 | $50 |
Calendar-Year Deductible – Family | $150 | $150 |
Deductible Waived for Preventive Services and Orthodontia | ||
Type I – Preventive Services | $0 | $0 |
Type II – Basic Services | 20% | 20% |
Type III – Major Services | 50% | 50% |
Calendar-Year Maximum | $2,000 per member | $2,000 per member |
Type IV – Orthodontia (children and adults) | 50% | 50% |
Orthodontia Lifetime Maximum | $2,000 per member | $2,000 per member |
*For out-of-network providers, you pay the amounts above, plus any amounts over usual, customary, and reasonable (UCR) charges.
You’ll generally pay less when you use a dentist in the Cigna network. The plan pays up to the UCR charges. You are responsible for any amount over UCR for services obtained by out-of-network providers.
Here’s an example. Let’s say you need to have a cavity filled. Compare the amount you would pay using the following providers.
Selected Covered Services and Frequency Limitations | |
---|---|
Type I – Preventive Services | |
Oral Exams (2 per calendar year) | Space Maintainers (limited to non-orthodontic) |
Cleanings (2 per calendar year) | Sealants (through age 14; 1 per tooth every 3 calendar years for children under age 14) |
Bitewing X-Rays (2 per calendar year) | Fluoride Treatment (2 per calendar year through age 14) |
Full Mouth X-Rays (1 every 3 calendar years) | Emergency Care to Relieve Pain |
Type II – Basic Services | |
Fillings | Periodontics |
Root Canal Therapy/Endodontics | Endodontics |
Periodontal Scaling and Root Planning | Anesthetics |
Oral Surgery | Surgical Extractions of Impacted Teeth |
Denture Adjustments and Repairs | Repairs to Bridges, Crowns, and Inlays |
Type III – Major Services | |
Crowns (replacement every 5 years if unserviceable and cannot be repaired) | Inlays (replacement every 5 years if unserviceable and cannot be repaired) |
Bridges (replacement every 5 years if unserviceable and cannot be repaired) | Onlays |
Dentures (replacement every 5 years if unserviceable and cannot be repaired) | Prosthesis over Implant (replacement every 5 years if unserviceable and cannot be repaired) |
Here’s how to make the most of your dental benefits:
Each time you need dental care, you have a choice of providers. Selecting a participating dentist in the Cigna network will ensure you receive the highest benefits from your plan. To find a provider, go to the Cigna website.
You should always submit a request for a pretreatment estimate for procedures and services your dentist believes will exceed $200 (procedures such as crowns, inlays, bridges, and periodontics).
You can review Explanation of Benefits (EOB) statements, check if claims have been paid, and more.
Visit Cigna where you’ll find a number of resources to help you get the most out of your dental coverage. Here’s what you can do online:
If you enroll for dental coverage as a new subscriber, you will receive a dental plan ID card in the mail. If you need a temporary ID card, you can obtain a copy online at Cigna.
The chart below shows the paycheck deduction you will pay on bi-weekly basis for your 2023 dental coverage.
Enrollment Tier | PPO Dental Cigna |
---|---|
Employee Only | $2.88 |
Employee + Spouse/DP* | $8.75 |
Employee + Child(ren) | $10.87 |
Family | $18.94 |
*Domestic partner premiums are subject to pre- and post-tax costs and includes imputed income.