DENTAL CIGNA
Although you can choose any dental provider, when you use an in-network dentist, you will generally pay less. If you choose an out-of-network provider, you may be billed the difference between what Cigna pays, and what your out-of-network provider charges for the services. If you use a Cigna DPPO Advantage provider (within the Cigna DPPO network), you’ll be responsible for a lower coinsurance amount. To locate an in-network provider, please visit mycigna.com.
Dental
Total Cigna DPPO
Cigna DPPO Advantage Cigna DPPO
Out-of-network
Annual deductible (Individual/Family)
$50 / $150
$50 / $150
Annual maximum (per person)
$1,500, Class I applies
$1,500, Class I applies
Diagnostic and preventive care Includes cleanings, fluoride treatments, sealants and x-rays Basic services Includes fillings, periodontics, scaling and root planning, and oral surgery Major services Includes crowns, bridges and full and partial dentures
100% covered, no deductible 100% covered, no deductible
10% after deductible
20% after deductible
20% after deductible
40% after deductible
50% after deductible
50% after deductible
Orthodontia
50%, no deductible
50%, no deductible
Orthodontia lifetime maximum
$1,500
$1,500
90th percentile of submitted charges
Non-network reimbursement
Based on contracted fees
Plan includes out-of-network benefits, see plan summary for additional details.
VISION CIGNA
Our vision care benefits include coverage for eye exams, lenses and frames, contact lenses, and discounts for laser surgery. The vision plan is built around the Cigna providers, who have higher benefits at a lower cost to you. When you need services, consider using an in-network provider for the most bang for your buck! When you use an out-of-network provider, you will be reimbursed for services according to the grid below. To locate an in-network provider, visit with mycigna.com.
Vision
In-network
Out-of-network
Examination (every 12 months)
$10 copay
$45 allowance
Material
$20 copay
N/A
Lenses (every 12 months) Single
Covered in full
$40 allowance
Bifocal
Covered in full
$65 allowance
Trifocal
Covered in full
$75 allowance
Frames (every 24 months) New frames
$130 allowance
$71 allowance
Contact lenses (every 12 months) Elective
$130 allowance
$105 allowance
Therapeutic
Covered in full
$210 allowance
Employees can elect dental and/or vision regardless of whether they are enrolled in medical.
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