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Plan Name Cigna Dental Care HMO Low Plan Cigna DPPO Advantage High PlanIn Network BenefitsDeductible(Applies to Basic & Major services only)N/A $50/$100Preventive Services 100% | 2 cleanings per calendar year 100% | 2 cleanings per calendar yearBasic Services Fee schedule 50% after deductibleMajor Services Fee schedule 50% after deductibleOrthodontia Lifetime Max(children only)Fee scheduleLifetime Maximum of $2,000Cigna will cover 50% of expense applied to a 1xlifetime maximum benefit of $2,000Annual Benefit Maximum Fee schedule$2,000the maximum Cigna will pay for the yearOut-of-Network BenefitsPreventive Services Not covered 100%*Basic Services Not covered 90%*Major Services Not covered 50%*Orthodontia Not covered 50% of the Maximum of $2,000*Deductible (Applies to Basic & Majorservices only)Not covered $50/$100*Annual Benefit Maximum Not covered $2,000*Orthodontia Lifetime Maximum Not covered $2,000*Low Plan High PlanCigna Dental Care HMO Low Plan Cigna DPPO Advantage High PlanEmployee $7.59 $9.89Employee + Spouse $16.44 $20.77Employee + Child(ren) $13.91 $19.79Family $21.49 $29.68Dental Plans*MAC: The out%u2010of%u2010network percentage of benefits is based on the %u201callowable amount%u201d applicable for the same service that would have been rendered by anetwork provider.**UCR: The out%u2010of%u2010network percentage of benefits is based on the %u201cusual and customary fees%u201d in the geographic areas in which the expenses are incurred.The network percentage of benefits is based on the discounted fees negotiated with the provider. See full plan summary for a more detailed plan explanationalong with a list of exclusions and limitationsRefer to your full plan summary for details on covered services.Dental Insurance Employee Cost Per Pay Period15Ardena offers two Cigna dental plans: Low DHMO and High PPO. Both plans cover100% of preventive services.