Dental Plan
Cigna Dental PPO Plan
Visit providers who are part of the DPPO network to keep your costs low.
Cigna Advantage | Cigna Dental PPO Plan | ||
|---|---|---|---|
In-Network | DPPO Network/Out of Network** | ||
Calendar Year Deductible | |||
Individual | $50 | $100 | |
Family | $100 | $200 | |
Annual Benefit Maximum Per Member (excluding orthodontia) | |||
Per Individual | $2,000 | $1,000 | |
You Pay | You Pay | ||
Preventive Care | |||
Exams, Cleanings, X-rays, Flouride Treatments | $0 | $0 | |
Basic Services | |||
Fillings, Space Maintainers, Sealants, Extractions, Oral Surgery, Endodontics, Periodontics, Emergency Exams | 10%* | 20%* | |
Major Procedures | |||
Crowns, Inlays/Onlays, Dentures and Bridgework, Repairs | 50%* | 50%* | |
Orthodontia | |||
24-Month Treatment Fee - Additional fees will apply for pre-ortho visits and treatment, records and retention and banding. | |||
Adults | 50%* up to lifetime maximum of $2,000 | 50%* up to lifetime maximum of $2,000 | |
Children | 50%* up to lifetime maximum of $2,000 | 50%* up to lifetime maximum of $2,000 | |
*After deductible
**Out-of-network provider fees over the Plan’s reasonable and customary limits are your responsibility.
Dental Plan
Cigna Dental PPO Plan
Visit providers who are part of the DPPO network to keep your costs low.
Cigna Advantage | Cigna Dental PPO Plan | ||
|---|---|---|---|
In-Network | DPPO Network/Out of Network** | ||
Calendar Year Deductible | |||
Individual | $50 | $100 | |
Family | $100 | $200 | |
Annual Benefit Maximum Per Member (excluding orthodontia) | |||
Per Individual | $2,000 | $1,000 | |
You Pay | You Pay | ||
Preventive Care | |||
Exams, Cleanings, X-rays, Flouride Treatments | $0 | $0 | |
Basic Services | |||
Fillings, Space Maintainers, Sealants, Extractions, Oral Surgery, Endodontics, Periodontics, Emergency Exams | 10%* | 20%* | |
Major Procedures | |||
Crowns, Inlays/Onlays, Dentures and Bridgework, Repairs | 50%* | 50%* | |
Orthodontia | |||
24-Month Treatment Fee - Additional fees will apply for pre-ortho visits and treatment, records and retention and banding. | |||
Adults | 50%* up to lifetime maximum of $2,000 | 50%* up to lifetime maximum of $2,000 | |
Children | 50%* up to lifetime maximum of $2,000 | 50%* up to lifetime maximum of $2,000 | |
*After deductible
**Out-of-network provider fees over the Plan’s reasonable and customary limits are your responsibility.
Part-time and Temporary employees are eligible for a limited subset of benefits. Union employees: refer to your collective bargaining agreement for your benefits eligibility.