
Dental Benefits
You can choose from two dental plans provided by Cigna: Dental Maintenance Organization (DMO) Plan or the Dental PPO Plan. Each type of plan has unique advantages. Understanding the differences can help you choose the coverage that best meets the needs of you and your family.
Plan Features
DMO Plan
- The DMO plan provides benefits only if you see an in-network DMO dentist.
- The plan requires you to choose a primary care dentist to coordinate all your care and provides benefits based on a copay schedule.
PPO Plan
- The PPO plan allows you to receive care from a dentist in the network or outside the network
- The PPO plan pays a portion of your expenses after you meet your annual deductible, except for preventive care which is covered at 100%
- WellnessPlusSM Progressive Maximum Benefit: When you or your family members receive any preventive care service during one plan year, the calendar year maximum will increase in the following plan year; until it reaches $1,800!
| Cigna | Dental DMO Dental Care Access Plus Network |
Dental PPO Total Cigna DPPO Network |
|
|---|---|---|---|
| Plan Benefits | In-Network Only | In-Network | Out-of-Network |
| Annual Deductible – Waived for Preventive (Single / Family) |
None | $50 / $150 | |
| Coinsurance (Paid by Carrier) | |||
| Diagnostic / Preventive | Fee Schedule | 100% | 100% |
| Basic | Fee Schedule | 80% | 80% |
| Endodontics | Fee Schedule | 80% | 80% |
| Periodontics | Fee Schedule | 80% | 80% |
| Oral Surgery | Not Covered | 80% | 80% |
| Major | Fee Schedule | 60% | 60% |
| Implants | Not Covered | 60% | 60% |
| TMJ | Not Covered | 50% | 50% |
| Orthodontics (Adult & Child) | $1,344 Child / $1,944 Adult |
50% | 50% |
| Orthodontia Lifetime Maximum* | None | $1,500 | |
| Calendar Year Maximum | None | $1,500 | |
| Out-of-Network UCR Level | N/A | N/A | 80th Percentile |
Note: Anyone who is in the middle of orthodontic treatment and joins our plan will be eligible for reimbursement subject to our plan benefits. The maximum benefit available will be pro-rated based on the amount of time left in the treatment cycle.
Enrolling in the DMO?
The DMO plan, also referred to as pre-paid plan, requires you to choose one dentist or dental facility to coordinate all of your oral health needs. If you need to see a specialist, your primary care dentist will refer you; specialty care may require preauthorization. Before you enroll in the DMO be sure to check that there is a DMO provider near you.
The DMO plan does not have any deductibles or maximums. Instead, when you receive a dental service, you pay a fixed dollar amount for the treatment.