Cigna DPPO Low Benefit Plan Summary (English)
Cigna DPPO Resumen del Plan de Beneficios (Español)
Cigna Dental Finding a Network Provider
- 100% In-Network and Out-of-Network, Class I Preventative & Diagnostic Care including routine oral exams, cleanings full, mouth x-rays, bitewing x-rays, panoramic x-ray, periapical x-rays, fluoride application, sealants, space maintainers, emergency care to relieve pain.
- 80%* In-Network and Out-of-Network, Class II Basic Restorative Care including fillings (amalgam and composite on all teeth), root canal therapy/endodontics, osseous surgery, periodontal scaling and root planing, denture adjustments and repairs, oral surgery - simple extractions, oral surgery - all except simple extractions, anesthetics, surgical extractions of impacted teeth, repairs to bridges, crowns and inlays.
- 50%* In-Network and Out-of-Network, Class III Major Restorative Care including crowns, dentures, bridges, inlays/onlays, prosthesis over implant.
- 50%* In-Network and Out-of-Network, Class IX Implants
- Orthodontia is not covered with the Cigna Dental DPPO Low Plan.
- Calendar year maximum for In-Network and Out-of-Network, Class I, II and III expenses is $1,000.
- Annual deductibles for In-Network and Out-of-Network, are $50 per person for an individual or $100 per family.
- Reimbursement levels for services provided by a Cigna Dental PPO network dentist, Cigna Dental will reimburse the dentist according to a Contracted Fee Schedule. For services provided by an out-of-network dentist, Cigna Dental will reimburse according to Reasonable and Customary Allowances but the dentist may balance bill up to their usual fees.
*subject to annual deductible
For more information and to see the complete list of eligible conditions, go to www.mycigna.com or call customer service 24/7 at 1.800.CIGNA24