What dental services are covered under the Cigna Dental Oral Health Integration Program?: 1
Condition
Chronic kidney disease
Radiation for head or neck cancers
Heart disease
Organ transplants
Rheumatoid arthritis
Sjogren's syndrome
Parkinson's disease
Huntington's disease
Opioid misuse and addiction
Stroke Diabetes Maternity
Lupus
ALS
Gum treatment 1,2 D4341 D4342 D4910 Gum evaluation 1,3 D0180 Oral evaluation 1,3 D0120 D0140 D0150
✓✓✓✓✓ ✓ ✓ ✓ ✓✓✓✓✓
✓
✓
✓
✓
Cleaning 1,4 D1110
✓
Scaling in the presence of inflammation 1,4 D4346 Palliative treatment of dental pain 1,5 D9110
✓
✓
Fluoride varnish 1,6 D1206
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓
Fluoride (no varnish) 1,6 D1208
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓
Sealants 6 D1351
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓
Sealant repair 6 D1353 Interim application of caries arresting medicament D1354 Caries preventive medicament application D1355
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
✓
1. Eligibility, reimbursement and coverage for eligible services are subject to plan year maximums. 2. Two additional treatments per year than the plan covers. 3. One additional evaluation. 4. One additional cleaning. 5. Unlimited visits. 6. Open to all ages, but plan limits apply.
Chat with us on myCigna.com or reach out 24/7 at 800.Cigna24 (800.244.6224) .
* You do not have to meet your DPPO or indemnity deductible to receive reimbursement for these services. However, reimbursement will apply to and is subject to your annual benefits maximum for traditional indemnity and DPPO plans as well as plan rules for visits to network dentists and out-of-network dentists. ** The reimbursement for out-of-network services will also be subject to plan limitations for out-of-network care costs. The Cigna Dental Oral Health Integration Program may not be available under your specific plan. Reimbursement under OHIP is subject to plan terms and conditions, including applicable annual benefit maximums and other exclusions and limitations. For costs and details of coverage, contact your Cigna Healthcare representative or see your plan documents. Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group. 830527 p 06/23 © 2023 Cigna Healthcare. Some content provided under license.
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