Dental Plan

Click here to view or download the Employee Per Pay Period Contributions document

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
Annual Deductible: None Advantage DPPO
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
  • Exams, Cleanings, X-Rays
See Fee Schedule 100% 80% 80% of UCR
Type II - Basic Services
  • Fillings
  • Root Canals
  • Uncomplicated Extractions
See Fee Schedule
See Fee Schedule
See Fee Schedule
80% After Deductible 80% After Deductible 80% of UCR
After Deductible
Type III - Major Services
  • Crowns
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.