Dental Plans

Cigna DPPO Low Plan

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

 

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Cigna DPPO High Plan with Orthodontia

  •  100% In-Network and Out-of-Network, Class I Preventative & Diagnostic Care including 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 IV Orthodontia. Lifetime maximum is $3,000.
  • 50% Class IX - Implants
  • Calendar year maximum for Class I, II and III expenses for In-Network and Out-of-Network is $2,000. 
  • 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.
  • Covers orthodontics in progress: “Orthodontics in Progress” refers to orthodontic treatment that began under a different carrier and continues into the new Cigna coverage period. Contributions may be available for patients whose teeth are being actively moved by bands or appliances (such as braces) at the time their Cigna dental coverage becomes effective. The Cigna plan covers orthodontics in progress, subject to your specific plan’s limitations. Keep in mind, new benefits do not change the terms of the contract you signed with your orthodontist prior to enrolling with Cigna. You are still responsible for the orthodontist’s total case fee.
  • Cigna will pay your orthodontist quarterly. If you have prepaid your bill, you can request that Cigna pays you directly.

*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

Cigna Customer Service

On the web:

www.MyCigna.com
By phone: 800.Cigna24 (800.244.6224)