Your Dental Benefits
Dental
Group # 00634554
Your employer has chosen Cigna for your dental benefits. The information below provides a high-level summary of your deductible, copays, prescriptions benefits and out-of-pocket costs.
| Total Network** | Total Network** 2 | |
|---|---|---|
| (Dental) Maximum (Class I, II, III Expenses) | ||
| In-Network | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 |
| Out-Of-Network | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 |
| Individual Deductible | ||
| In-Network | $50 | $50 |
| Out-Of-Network | $50 | $50 |
| Family Deductible | ||
| In-Network | $150 | $150 |
| Out-Of-Network | $150 | $150 |
| (Dental) Class I Expenses -Preventive & Diagnostic Care | ||
| In-Network | 100%, No Deductible | 100%, No Deductible |
| Out-Of-Network | 100%, No Deductible | 100%, No Deductible |
| (Dental) Class II Expenses - Basic Restorative Care | ||
| In-Network | 100%, After Deductible | 80%, After Deductible |
| Out-Of-Network | 100%, After Deductible | 80%, After Deductible |
| (Dental) Class III Expenses - Major Restorative Care | ||
| In-Network | 60%, After Deductible | 50%, After Deductible |
| Out-Of-Network | 60%, After Deductible | 50%, After Deductible |
| Total Network** | |
|---|---|
| In-Network | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 |
| Out-of-Network | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 |
| Total Network** 2 | |
|---|---|
| In-Network | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 |
| Out-of-Network | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 |
| Total Network** | |
|---|---|
| In-Network | $50 |
| Out-of-Network | $50 |
| Total Network** 2 | |
|---|---|
| In-Network | $50 |
| Out-of-Network | $50 |
| Total Network** | |
|---|---|
| In-Network | $150 |
| Out-of-Network | $150 |
| Total Network** 2 | |
|---|---|
| In-Network | $150 |
| Out-of-Network | $150 |
| Total Network** | |
|---|---|
| In-Network | 100%, No Deductible |
| Out-of-Network | 100%, No Deductible |
| Total Network** 2 | |
|---|---|
| In-Network | 100%, No Deductible |
| Out-of-Network | 100%, No Deductible |
| Total Network** | |
|---|---|
| In-Network | 100%, After Deductible |
| Out-of-Network | 100%, After Deductible |
| Total Network** 2 | |
|---|---|
| In-Network | 80%, After Deductible |
| Out-of-Network | 80%, After Deductible |
| Total Network** | |
|---|---|
| In-Network | 60%, After Deductible |
| Out-of-Network | 60%, After Deductible |
| Total Network** 2 | |
|---|---|
| In-Network | 50%, After Deductible |
| Out-of-Network | 50%, After Deductible |
All plans have exclusions and limitations. For a summary of these exclusions and limitations, view the Benefit Summary.
In Texas, the insured dental plan is known as Cigna Dental Choice and this plan uses the national Cigna DPPO network.
The term "DHMO" refers to group dental products that may differ by the state an enrollee lives in including prepaid plans, managed care plans, and plans with open access features. The Cigna Dental Care (DHMO) plan is not available in all states. In mosts states, the Cigna Dental Care (DHMO) plan does not include coverage out-of-network (except for emergency dental care). Certain states mandate coverage for dental care received out-of-network. For example, in Minnesota, the plan will pay 50% of the value of the network benefit for covered out-of-network services. In Oklahoma, the plan will pay the same amount it pays network dentists for covered out-of-network services. Customers are responsible for any charges not covered by the plan. Other states may have similar mandates. For cost and coverage details, see your plan documents or contact a Cigna representative.
Dental
Group # 00634554
Your employer has chosen Cigna for your dental benefits. The information below provides a high-level summary of your deductible, copays, prescriptions benefits and out-of-pocket costs.
| Total Network** | Total Network** 2 | |
|---|---|---|
| (Dental) Maximum (Class I, II, III Expenses) | ||
| In-Network | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 |
| Out-Of-Network | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 |
| Individual Deductible | ||
| In-Network | $50 | $50 |
| Out-Of-Network | $50 | $50 |
| Family Deductible | ||
| In-Network | $150 | $150 |
| Out-Of-Network | $150 | $150 |
| (Dental) Class I Expenses -Preventive & Diagnostic Care | ||
| In-Network | 100%, No Deductible | 100%, No Deductible |
| Out-Of-Network | 100%, No Deductible | 100%, No Deductible |
| (Dental) Class II Expenses - Basic Restorative Care | ||
| In-Network | 100%, After Deductible | 80%, After Deductible |
| Out-Of-Network | 100%, After Deductible | 80%, After Deductible |
| (Dental) Class III Expenses - Major Restorative Care | ||
| In-Network | 60%, After Deductible | 50%, After Deductible |
| Out-Of-Network | 60%, After Deductible | 50%, After Deductible |
| Total Network** | |
|---|---|
| In-Network | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 |
| Out-of-Network | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 |
| Total Network** 2 | |
|---|---|
| In-Network | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 |
| Out-of-Network | Class I does not apply Year 1: $1500, Year 2: $1600 Year 3: $1700, Year 4: $1800 |
| Total Network** | |
|---|---|
| In-Network | $50 |
| Out-of-Network | $50 |
| Total Network** 2 | |
|---|---|
| In-Network | $50 |
| Out-of-Network | $50 |
| Total Network** | |
|---|---|
| In-Network | $150 |
| Out-of-Network | $150 |
| Total Network** 2 | |
|---|---|
| In-Network | $150 |
| Out-of-Network | $150 |
| Total Network** | |
|---|---|
| In-Network | 100%, No Deductible |
| Out-of-Network | 100%, No Deductible |
| Total Network** 2 | |
|---|---|
| In-Network | 100%, No Deductible |
| Out-of-Network | 100%, No Deductible |
| Total Network** | |
|---|---|
| In-Network | 100%, After Deductible |
| Out-of-Network | 100%, After Deductible |
| Total Network** 2 | |
|---|---|
| In-Network | 80%, After Deductible |
| Out-of-Network | 80%, After Deductible |
| Total Network** | |
|---|---|
| In-Network | 60%, After Deductible |
| Out-of-Network | 60%, After Deductible |
| Total Network** 2 | |
|---|---|
| In-Network | 50%, After Deductible |
| Out-of-Network | 50%, After Deductible |
All plans have exclusions and limitations. For a summary of these exclusions and limitations, view the Benefit Summary.
In Texas, the insured dental plan is known as Cigna Dental Choice and this plan uses the national Cigna DPPO network.
The term "DHMO" refers to group dental products that may differ by the state an enrollee lives in including prepaid plans, managed care plans, and plans with open access features. The Cigna Dental Care (DHMO) plan is not available in all states. In mosts states, the Cigna Dental Care (DHMO) plan does not include coverage out-of-network (except for emergency dental care). Certain states mandate coverage for dental care received out-of-network. For example, in Minnesota, the plan will pay 50% of the value of the network benefit for covered out-of-network services. In Oklahoma, the plan will pay the same amount it pays network dentists for covered out-of-network services. Customers are responsible for any charges not covered by the plan. Other states may have similar mandates. For cost and coverage details, see your plan documents or contact a Cigna representative.