Page 11 - 2022 DPR Construction Benefit Guide_Craft Employees

Dental Plan

Your dental health is an important part of your overall wellness. Dental insurance gives you a reason to smile – it’s affordable
and covers preventive care (including regular checkups), as well as fillings, bridges, crowns and orthodontia services.
DPPO Dental Plan

With the PPO dental plan, you may visit any dentist of your choice. Keep in mind, you’ll receive the highest coverage when
you use an in-network provider. If you visit an out-of-network provider, you will pay more out-of-pocket for services. Visit
mycigna.com for provider directory.

DPPO PLAN
IN-NETWORK OUT-OF-NETWORK*
CALENDAR YEAR DEDUCTIBLE
Individual $50 $75
Family $150 $225

CALENDAR YEAR PLAN MAXIMUM
Per Individual $2,000 per individual
YOU PAY

PREVENTIVE CARE
Exams, Cleanings, X-rays, Fluoride Treatments No Charge No Charge
BASIC SERVICES
Fillings, Space Maintainers, Sealants, Extractions,
Oral Surgery, Endodontics, Periodontics, 20%** 20%**
Emergency Exams

MAJOR PROCEDURES
Crowns, Inlays/Onlays, Dentures and 50%** 50%**
Bridgework, Repairs
ORTHODONTIA

50% up to a lifetime maximum benefit of
Adults and Children
$2,500 per individual; deductible waived
* Out-of-network reimbursement is based on the 90th percentile of all provider charges in the geographic area. You are responsible for charges above
that amount.
** Deductible applies

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