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.

With the dental plan, you get:

Free in-network preventive and diagnostic care,

including cleanings and X-rays.

Affordable coverage

that helps you manage the cost of dental treatment.

A wide network of providers

that have agreed to negotiated rates, which helps you save money.

2023 Coverage Details

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 in 2023 (or the Delta Dental network in 2024). 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.

  • An out-of-network dentist charges $100 for this service, and the UCR is $50. You are responsible for paying 20% of $50 ($10) PLUS the $50 over UCR. Your total bill is $60.
  • An in-network dentist is paid the negotiated rate of $40 for this service, and you are responsible for 20% of $40. Your total bill is $8.
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)


2024 Coverage Details

Here’s a brief overview of dental plan benefits in 2024 with Delta Dental.

Delta Dental:
PPO Dentists*
Delta Dental:
Premier Dentists*
Non-Delta Dental:
(waived for preventive/diagnostic and orthodontia services)
Preventive & Diagnostic Services
(exams, cleanings, X-rays, sealants, space maintainers)
100% 100% 100%
Basic Services
(fillings, simple extractions, posterior composites, denture repair/reline/rebase)
80% 80% 80%
(root canals)
80% 80% 80%
(surgical and non-surgical)
80% 80% 80%
Oral Surgery 80% 80% 80%
(bridges, dentures)
50% 50% 50%
Implants 50% 50% 50%
Orthodontic Services
(adults and dependent children)
50% 50% 50%

* Reimbursement is based on the Delta Dental maximum contract allowances and not necessarily each dentist's submitted feeds. Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists, and the program allowance for non-Delta Dental dentist.

What's the difference in coverage for PPO, Premier, and non-Delta dentists?

Your provider options are:

  • Delta Dental PPO dentists: To maximize your savings, use these providers. They've agreed to reduced fees and you won't get charged more than your expected share of the bill.
  • Delta Dental Premier providers: If you can't find a PPO dentist, consider a Premier provider. Keep in mind, these dentists offer smaller discounts than PPO providers, so your costs will be higher.
  • Non-Delta Dental dentists: If you use a dentist who is not affiliated with Delta Dental, your costs will be the highest. Plus, these providers may choose to “balance bill" you. This happens if your dentist charges more than the amount the insurance company pays. In this situation, your dentist may choose to bill you for the excess portion this is not covered by insurance.

Use Your Dental Benefits Wisely

Here’s how to make the most of your dental benefits:

Choose a provider.

Selecting a participating dentist in the dental plan's network will ensure you receive the highest benefits.

To find a provider in 2023, go to the Cigna website.

To find a provider in 2024, go to the Delta Dental website:

  • From the top navigation, click Find a dentist.
  • For the “network,” choose Delta Dental PPO for the highest level of coverage, or Delta Dental Premier for lower coverage. 

If your service will exceed $200, submit for a pretreatment estimate.

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).

Check your claim status and other information at Cigna (in 2023) or Delta Dental (in 2024).

You can review Explanation of Benefits (EOB) statements, check if claims have been paid, and more.

In 2023, use the Cigna dental tools. (Coming soon! In 2024, you’ll have access to Delta Dental tools.)

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:

  • myCigna Mobile App gives you a simple way to personalize, organize, and access your important dental information — on the go. Search for a dentist from the Cigna national network, get important details on your plan, like what you’ll pay in- and out-of-network, view and search recent and past dental claims, and much more.
  • Brighter Score is a scoring method to compare dentists. The score is derived from factors such as affordability, patient experience, and professional history. It can help you find:
    • Dental office reviews and comparisons. Find detailed information to compare dental offices, view dentist profiles with pictures and video content, and read verified patient reviews.
    • Online appointment scheduling. If your dentist offers this service, you can schedule appointments online and receive reminders.
    • Enhanced searching and transparent pricing. Search for a dentist by a procedure or group of procedures. Information is personalized for your specific plan and shows out-of-pocket costs, including coinsurance and deductibles.

Dental ID Cards

You will not receive a physical ID card for dental coverage, as it's not required to access services. However, if you'd like an ID card, you may download a copy online from Cigna (or from Delta in 2024).

Dental Plan Premiums

The chart below shows the paycheck deduction you will pay on a bi-weekly basis for your 2023/2024 dental coverage.

Enrollment Tier 2023:PPO Dental Cigna
2024: PPO Dental Delta Dental
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.