Dental Plan
Our dental plans consist of two choices: a Dental Maintenance Organization (DMO) Plan and a Preferred Provider Organization (PPO) plan, both offered by Cigna Dental. The DHMO Plan requires you to elect a Primary Care Dentist (see fee schedule here). If the employee selects the PPO, they may use any dental care provider. However, when electing a provider within the Cigna PPO network, the out-of-pocket costs will likely be lower than if an out-of-network provider is used.
| Cigna Dental Plans Group #: 3337191 Phone #: 800-244-6224 |
DHMO* | PPO | ||
|---|---|---|---|---|
| Annual Deductible: | None | Advantage DPPO Network |
In-Network | Out-of-Network |
| $50 per Person (3 x Family) |
$50 per Person (3 x Family) |
$50 per Person (3 x Family) |
||
| Annual Maximum | Unlimited | $1,500 | $1,500 | $1,500 |
Type I - Preventive Services
|
See Fee Schedule | 100% | 80% | 80% of UCR |
Type II - Basic Services
|
See Fee Schedule See Fee Schedule See Fee Schedule |
80% After Deductible | 80% After Deductible | 80% of UCR After Deductible |
Type III - Major Services
|
See Fee Schedule | 50% After Deductible | 50% After Deductible | 50% of UCR After Deductible |
| Orthodontia | Children - $1,608 Adult - $1,800 |
Not Covered | ||
* Member co-payments based upon Cigna’s published fee schedule. **Late Entrants subject to waiting periods. See EOC for details.
