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.
including cleanings and X-rays.
that helps you manage the cost of dental treatment.
that have agreed to negotiated rates, which helps you save money.
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.
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 a brief overview of dental plan benefits in 2024 with Delta Dental.
Delta Dental: PPO Dentists* |
Delta Dental: Premier Dentists* |
Non-Delta Dental: Dentists* |
|
---|---|---|---|
Deductible
(waived for preventive/diagnostic and orthodontia services)
|
$50/individual
$150/family |
$50/individual
$150/family |
$50/individual
$150/family |
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% |
Endodontics
(root canals) |
80% | 80% | 80% |
Periodontics
(surgical and non-surgical) |
80% | 80% | 80% |
Oral Surgery | 80% | 80% | 80% |
Prosthodontics
(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.
Your provider options are:
Here’s how to make the most of your dental benefits:
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:
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:
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).
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.