Cigna Dental PPO Low Option + Cigna Dental PPO High Option MAA offers two dental plan options through Cigna. Both plans give you the flexibility to receive care in or outside of Cigna’s DPPO Network. However, when you receive care in-network, your costs are lower. Those who need less care can pay less by choosing the Low Option, while those who need more care, including Orthodontia, can choose the High Option. 2020 Bi-Weekly Associate Payroll Contributions by dental plan option & coverage level Dental PPO Low Option Dental PPO High Option Employee Only $9.61 $13.51 Employee + Spouse $20.20 $28.38 Employee + Child(ren) $17.31 $29.72 Employee + Family $23.08 $40.54
Cigna Dental PPO Low Option
Cigna Dental PPO high Option
Benefit
In-network
Out-of-network
In-network
Out-of-network
Maximum Reimbursable Charge (MRC)
Based on Contracted Fees
Maximum Reimbursable Charge (MRC)
Based on Contracted Fees
Reimbursement Levels
Calendar Year Deductible
Individual Family
$50 $150
$50 $150
$50 $150
$50 $150
$1,500 per person Applies to Class I, II, III expenses
$1,500 per person Applies to Class I, II, III expenses
$2,500 per person Applies to Class I, II, III & IX expenses
$2,500 per person Applies to Class I, II, III & IX expenses
Calendar Year Benefits Maximum
Class I: Diagnostic & Preventative Oral Exams, Cleanings, X-rays, Fluoride Application, Sealants Class II: Basic Restorative Fillings, Periodontics, Oral Surgery, Repairs to Bridges, Crowns and Dentures Class III: Major Restorative Inlays and Onlays, Prosthesis Over Implant, Crowns, Bridges, and Dentures Class IV : Orthodontia Coverage for Adults & Children Lifetime Benefits Maximum: $2,500
Plan pays 100% of MRC
Plan pays 100%
Plan pays 100% of MRC
Plan pays 100%
After Deductible, Plan pays 80% You pay 20%
After Deductible, Plan pays 80% of MRC You pay remainder
After Deductible, Plan pays 80% You pay 20%
After Deductible, Plan pays 80% of MRC You pay remainder After Deductible Plan pays 60% of MRC You pay remainder No Deductible Plan pays 50% up to Lifetime Benefits Maximum After Deductible, Plan pays 50% You pay remainder
After Deductible Plan pays 50% You pay 50%
After Deductible Plan pays 50% of MRC You pay remainder
After Deductible Plan pays 60% You pay 40%
No Deductible Plan pays 50% up to Lifetime Benefits Maximum
Not Covered
Class IX: Implants
After Deductible, Plan pays 50% You pay 50%
Not Covered
Plan Links Click here for the benefit summary for the Cigna PPO Low Option. Click here for the benefit summary for the Cigna PPO High Option.
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