Dental Plan

Cigna Dental PPO Plan

Visit providers who are part of the DPPO network to keep your costs low.

Cigna DPPO
CIGNA ADVANTAGE NETWORKCIGNA DPPO NETWORK/ OUT-OF-AREA**OUT-OF-NETWORK***
Calendar Year Deductible
Individual$50$100$100
Family$100$200$200
Annual Benefit Maximum Per Member (excluding orthodontia)
Per Individual$2,000$1,000
You PayYou PayYou Pay
Preventive Care
Exams, Cleanings, X-rays, Flouride Treatments$0
Basic Services
Fillings, Space Maintainers, Sealants, Extractions, Oral Surgery, Endodontics, Periodontics, Emergency Exams10%*20%*10%*
Major Procedures
Crowns, Inlays/Onlays, Dentures and Bridgework, Repairs50%*50%*50%*
Orthodontia
24-Month Treatment Fee - Additional fees will apply for pre-ortho visits and treatment, records and retention and banding.
Adults50%* up to lifetime maximum of $2,000
Children (up to 19th birthday)50%* up to lifetime maximum of $2,000
*Copay applies after plan deductible is met.
**For employees who do not have a participating primary dentist within 25 miles of their home.
***Out-of-network provider fees over the Plan’s reasonable and customary limits are your responsibility