Page 17 - NRDC Benefits Guide for 2022

Dental Insurance

Our dental plan helps you maintain good dental health through an affordable plan, including regular checkups
and other dental work. The dental plan option is designed to encourage preventive treatment, allowing you to
achieve oral health while striving to minimize dental costs. Coverage is provided through Cigna.

Dental Plan at-a-Glance

The chart below summarizes the dental plan coverage provided by Cigna. The Cigna dental plan utilizes
progressive calendar year maximums. This means when you receive your preventive services, your annual
maximum benefit will increase year-over-year.

PPO Dental Plan Find a Provider
Out of
In-Network
Network • Call 1-800-244-6224 or log onto
Annual Deductible (Single / $50 / $100 $75 / $150 myCigna.com to access information
Family) about your dental plan
Year 1: $4,000 • Be sure to use the DPPO Network
Calendar Year Maximum* (per Year 2: 4,150 when you search
person) Year 3: $4,300
Year 4: $4,450
Diagnostic / Preventive
Oral Exams, Routine Cleanings Covered 100% 10% After
(two per calendar year), X-rays,
Fluoride Treatments (children) After Ded. Ded.
Basic Services
Fillings, Extractions, Endontics,
Periodontics, Oral Surgery, 20% After 30% After
Anesthesia, Repairs on Inlays, Ded. Ded.
Onlays, Dentures, Bridges
Major Services
Inlays, Onlays, Crowns, 50% After 50% After
Bridges, Dentures, Implants Ded. Ded.
Orthodontia - Adults and
Dependent Children
Orthodontic Services 50% After Ded.
Orthodontic Lifetime Maximum
(per person) $2,500

Dental Contributions (Bi-weekly Rates)
PPO Dental Plan

You Pay NRDC Pays
Individual Coverage $9.97 $14.94

Individual +1 Coverage $21.58 $32.37
Family Coverage $32.37 $48.55

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