Overview
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, administered by Cigna, you can receive:
Free in-network preventive and diagnostic care
Affordable coverage that helps you manage the cost of dental treatment
Wide network of providers that have agreed to negotiated rates, which helps you save money
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. 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) |
Use Your Dental Benefits Wisely
Here’s how to make the most of your dental benefits:
Choose a provider.
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.
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.
You can review Explanation of Benefits (EOB) statements, check if claims have been paid, and more.
Use the Cigna 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
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.
Dental Plan Premiums
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.