To see if a provider is in the network, log on to myCigna.com or use the myCigna mobile App. alex ® 2019 bi-Weekly associate payroll contributions by dental plan option & coverage level Dental PPO Low Option Dental PPO High Option
Employee Only
$8.77
$10.57
Employee + Spouse
$18.42
$22.19
Employee + Child(ren)
$15.79
$23.24
Employee + Family
$21.05
$31.70
Based on Contracted Fees
MaximumReimbursable Charge (MRC)
Based on Contracted Fees
MaximumReimbursable Charge (MRC)
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%
Plan pays 100% of MRC
Plan pays 100%
Plan pays 100% of MRC
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 50% You pay 50%
After Deductible Plan pays 50% of MRC You pay remainder
After Deductible Plan pays 60% You pay 40%
After Deductible Plan pays 60% of MRC You pay remainder
No Deductible Plan pays 50% up to Lifetime Benefits Maximum
No Deductible Plan pays 50% up to Lifetime Benefits Maximum
Not Covered
Class IX: Implants
After Deductible, Plan pays 50% You pay 50%
After Deductible, Plan pays 50% You pay remainder
Not Covered
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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