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Benefits

Dental Insurance

Option 1
Cigna | DHMO Dental Plan

With the Dental Health Maintenance Organiza on (DHMO) plan through Cigna, you are required to select a general den st to
provide your dental care. You will contact your general den st for all of your dental needs, such as rou ne check‐ups and
emergency situa ons. If specialty care is needed, your general den st will provide the necessary referral. For covered procedures,
you'll pay the pre‐set copay or coinsurance fee described in your DHMO plan booklet. Please keep a copy of your booklet to refer
to when u lizing your dental care. This will show the applicable copays that apply to all of the dental services that are covered
under this plan. You will be receiving an ID card for this plan.

Option 2
Cigna | PPO Dental Plan
With the Cigna Preferred Provider Organiza on (PPO) dental plan, you may visit a PPO den st and benefit from the nego ated rate
or visit a non‐network den st. When you u lize a PPO den st, your out‐of‐pocket expenses will be less. You may also obtain
services using a non‐network den st; however, you will be responsible for the difference between the covered amount and the
actual charges and you may be responsible for filing claims. You will not be receiving an ID card for this plan.

Cigna Cigna
Plan Name DHMO PPO
Network Name Cigna Dental Care DHMO Cigna Dental PPO Non‐Network
Advantage
Dental Benefits

Office Visit Copay $5 Copay N/A N/A
Calendar Year Maximum Unlimited $1,750 $1,500
Deduc ble (Annual)
‐ Individual $0 $25 $50
‐ Family $0 $50 $100
Preven ve Covered 100% for Most Services No Charge 10%
Exams, X‐Rays, Cleanings

Basic Services See Copay Schedule Deduc ble, 10% Deduc ble, 30%
Fillings, Oral Surgery,
Endodon cs, Periodon cs
Major Services See Copay Schedule Deduc ble, 40% Deduc ble, 50%
Crowns, Prosthe cs

Orthodon a
‐ Covered Members Children & Adults Children & Adults
‐ Copay $1,600 Child / $2,600 Adult N/A
‐ Coinsurance N/A 50%
‐ Life me Benefit Maximum N/A $1,000

Finding a Dental Provider
Go to www.mycigna.com.
 Op on 1 DHMO: Refer to the “Cigna Dental Care DHMO” network when prompted.
 Op on 2 PPO: Refer to the “Cigna Dental PPO Advantage” network when prompted.

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