Page 10 - 5.11 Benefit Guide 2019 EXECUTIVE
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DENTAL
With the Cigna Preferred Provider Organization (PPO) dental plan, you may visit a PPO dentist and benefit from the negotiated
rate or visit a non-network dentist. When you utilize a PPO dentist, your out-of-pocket expenses will be less. You may also
obtain services using a non-network dentist; however, you will be responsible for the difference between the covered amount
and the actual charges and you may be responsible for filing claims.
CIGNA
PPO PLAN
NETWORK Network Non-Network
DENTAL BENEFITS
Calendar Year Maximum Benefit $2,250
Annual Deductible
• Individual None $50
• Family None $150
Preventive Services (Plan Pays) 100% 100%
• Deductible Waived
Basic Services (Plan Pays) 100% Ded, 80%
Major Services (Plan Pays) 60% Ded, 50%
Orthodontia
• Covered Family Members Adult & Children
• Lifetime Benefit Maximum $2,000
• Coinsurance 50%
FINDING A DENTAL PROVIDER:
You can locate a dentist through Cigna’s online directory. Go to www.cigna.com and click find a Doctor.
On the right side of the page, under “Not a Cigna Customer Yet?” select “Plans through your employer
or school” and then the Dentist tab. When prompted to select a plan, please choose “Cigna Dental
PPO or EPO”.
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