Dental Plans
Administrator: Cigna Health and Life Insurance Company
Website: http://www.cigna.com/
Phone: 1-800-CIGNA24
Mobile App: myCigna® Mobile App
You may elect one of the dental options offered under the Plan or choose no coverage at all. This election is independent of your medical election.
The Traditional Dental Plan (Dental PPO) provides payment for the following covered services, subject to the plan maximums and limitations:
Class schedule:
| Class I | Diagnostic and Preventive (no more than two in any calendar year). | 100% of Contract Fee or Maximum Reimbursable Charge |
|---|---|---|
| Class II | Basic Restorative, Endodontics, Periodontics, Maintenance of Prosthodontics and Oral Surgery | 80% of Contract Fee or Maximum Reimbursable Charge |
| Class III | Major Restorative, Installation of Prosthodontics | 60% of Contract Fee or Maximum Reimbursable Charge |
| Class IV | Orthodontics | 60% of Contract Fee or Maximum Reimbursable Charge |
The maximum benefit, excluding Class IV Services, is $2,000 per person each year. The lifetime maximum for Class IV Services (orthodontics) is $1,000 per person. Each year, you will need to meet a deductible of $50 per person, or $150 for family. The deductible does not apply to Class I and Class IV Services. As an additional plan feature, if you use a dentist who is a member of the Preferred Provider Organization (PPO), charges for covered services will usually be discounted. This means your cost will usually be less than that associated with a dentist who is not a member of the PPO. Please remember that under the Traditional Dental Plan (Dental PPO), you may use any dentist you wish; use of the PPO feature is voluntary. Out of network claims submitted to CIGNA after 365 days from date of service will be denied.
CIGNA Dental PPO Summary (Texas Residents only)
CIGNA Dental PPO Certificate of Plan Booklet
CIGNA Dental PPO Certificate of Plan Booklet (Texas Residents Only)
CIGNA Dental PPO Transition of Care Customer FAQ Flyer
Dental Claim Form
How to find a PPO Dentist
CIGNA Dental PPO Ortho in Progress
CIGNA Dental PPO Wellness Plus Maximum Rollover Program
The Dental HMO (DHMO) is an alternative option to the Traditional Dental Plan and operates much like a medical HMO. The key features of the plan include: No charge or modest patient charges for diagnostic/preventive and restorative procedures, as well as oral surgery, fixed patient charges for services associated with crowns and bridges, endodontics, periodontics, prosthetics, denture relining and orthodontics (24 month maximum lifetime benefit for orthodontic services), the patient charge schedule applies only when procedures are performed by a network dentist; procedures performed by a non-network dentist are not covered, only the procedures listed on the patient charge schedule for the Dental HMO (DHMO) will be covered; those procedures not listed will not be covered, and visits to a network specialist, such as an Endodontist, Periodontist, Orthodontist, Oral Surgeon, or Pediatric Dentist (under the age of 7) require a signed specialty referral form from the patient’s primary dentist.
CIGNA Dental DHMO Certificate of Plan Booklet
CIGNA Dental Fee DHMO Schedule (Summary)
CIGNA Dental DHMO Ortho in Progress
How to find a DHMO Dentist
Frequently Ask Questions (FAQs)