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2014 Dental Insurance: myCigna Dental 1500 Plan Details
Individual | Family$50** Individual | $150** Family
Annual Benefit Maximum
Individual | Family$1,500 per person Individual
Lifetime Individual Orthodontia Deductible$50
per person, per month
|Individual annual deductible||$50 per person (waived for preventive services)||$50 per person (waived for preventive services)|
|Family annual deductible||$150 per family (waived for preventive services)||$150 per family (waived for preventive services)|
|Annual Benefit Maximum||$1,500 per person||$1,500 per person|
|Separate lifetime individual orthodontia deductible||$50||$50|
|Preventive/Diagnostic Services Waiting Period||No waiting period||No waiting period|
|Preventive Diagnostic Services (Oral exams, cleanings, x-rays, fluoride application, sealants, non-orthodontic space maintainers)||You pay 0%, deductible waived||You pay 0% (for North Carolina, you pay 5%), deductible waived|
|Oral Exams||1 per consecutive 6-month period|
|Routine Cleanings||1 routine prophylaxis or periodontal maintenance procedure per consecutive 6-month period (routine prophylaxis is Class I; periodontal maintenance procedure is Class III).|
|Routine X-Rays||Bitewings: 1 set in any consecutive 12-month period. Limited to a maximum of 4 films per set|
|Fluoride Treatment||1 per consecutive 12 months for participants less than age 14|
|Sealants||1 treatment per tooth per lifetime. Payable on unrestored permanent bicuspid or molar teeth for participants less than age 14|
|Space Maintainers (non-orthodontic)||Limited to non-orthodontic treatment for prematurely removed or missing teeth for a person less than 14 years old|
|Basic Restorative Services Waiting Period||6-month waiting period **||6-month waiting period **|
|Basic Restorative Services (Fillings, non-routine x-rays) In-network discounts apply||You pay 20% after deductible||You pay 20% (for North Carolina, you pay 25%) after deductible|
|Fillings||1 per tooth per 12 consecutive months (applies to replacement of identical surface fillings only). No white/tooth colored fillings on bicuspid or molar teeth|
|Non-routine X-Rays||Full mouth or Panorex: 1 per 60 consecutive months|
|Routine Tooth Extraction||Includes an allowance for local anesthesia and routine postoperative care|
|Emergency Treatment||Paid as a separate benefit only if no other service, except x-rays, is rendered during the visit|
**For West Virginia customers, 3-month waiting period applies. For Missouri and Rhode Island customers, waiting period does not apply.
|Major Restorative Services Waiting Period||12-month waiting period **||12-month waiting period **|
|Major Restorative Services
In-network discounts apply
|You pay 50% after deductible||You pay 50% (for North Carolina, you pay 55%) after deductible|
|Crowns and Inlays||Replacement limited to 1 per 84 consecutive months. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth-colored material on molar crowns or bridges. Replacement must be indicated by major decay. For participants less than age 16, benefits limited to resin or stainless steel|
|Root Canal Therapy/Endodontics||1 per tooth per lifetime|
|Minor Periodontics||Root planing—1 per quadrant per 36 consecutive months|
|Major Periodontics||1 per 36 consecutive months per area of the mouth (same service)|
|Relines, Rebases (Denture)||Limited to relining or rebasing Dentures done more than a consecutive 12-month period after the initial insertion, and then not more than one time in any consecutive 36-month period|
|Denture Adjustments||Only covered 1 time in any consecutive 12-month period and only if performed more than 12 consecutive months after the insertion of the denture|
|Repairs — Bridges and Dentures||Covered if more than 12 months after installation|
|Dentures and Partials||1 per arch per 84 consecutive month period|
|Bridges||Benefits will be considered for the initial replacement of a Necessary Functioning Natural Tooth extracted while the person was covered under this plan|
|Wisdom Teeth Removal (Impacted)||Includes an allowance for local anesthesia and routine postoperative care|
**For West Virginia customers, 3-month waiting period applies. For New Jersey and Vermont customers, 6-month waiting period applies. For Missouri and Rhode Island customers, waiting period does not apply.
|Orthodontia Waiting Period||12-month waiting period *||12-month waiting period *|
In-network discounts apply
|You pay 50% after $50 separate lifetime orthodontia deductible||You pay 50% (for North Carolina, you pay 55%) after $50 separate lifetime orthodontia deductible|
|Orthodontia Individual Lifetime Maximum||$1,000 per person||$1,000 per person|
|Orthodontia||The total amount payable for all expenses incurred for orthodontics during a person’s lifetime will not be more than the orthodontia maximum|
You may pay more for out-of-network charges if the dentist’s charges exceed the amount Cigna reimburses for billed services.
You may be eligible to waive the waiting period with prior qualified coverage, not applicable to orthodontia.
This summary contains highlights only and is subject to change.
When you know you need dental care…
You’ve heard it from the dentist. You or a family member needs orthodontia care. With this plan, you get a special $1,000 orthodontia benefit that applies to anyone, with a small one-time deductible. Your restorative services—including crowns, bridges and fillings—are covered up to $1,500, a real savings for your family.
- 100% coverage for all annual exams, routine x-rays and cleanings with no waiting period, once your plan is effective.1 You can see the dentist right now, if necessary.
- Cigna pays 100% on all qualified procedures up to $1,500, including preventive and diagnostic services.
- $50 individual/$150 family annual deductible is waived for preventive and diagnostic services.
- After the deductible, Cigna covers a portion of restorative procedures up to $1,500— including crowns, bridges, fillings, root canals and dentures—which also helps your wallet.
- A $1,000 lifetime orthodontia benefit applies to people of all ages, with a one-time $50 deductible—a truly special benefit to fit your specific need.
- If you have records of dental insurance before you joined Cigna, we will waive the waiting period (not applicable to orthodontia), so you can start accessing your services right away rather than having to wait six months for basic restorative services or a year for major restorative services.2
In every myCigna plan...
to help keep you smiling…
It's easier to manage your dental care with:
- Convenient billing and payments. Get your medical and dental insurance statements on one bill. Of course, if you have a dental plan and no medical, you will only receive a dental statement.
- No claims submissions. Cigna network dentists submit claims automatically.
- No need to choose a primary dentist. And no referrals needed for specialist care.
- Freedom to choose a dentist from our large national network or you have the option to select a dentist outside the network. Keep in mind, you’ll save the most if you stay in-network.
- 24/7 live customer service for dental benefits and claims information. Call 1.800.244.6224 anytime.
- Online access with myCigna.com. View bills and claims online, anytime—and pay your bills online.
- Mobile access on the go. Find a dentist, check coverage and show your ID card with the myCigna Mobile app.3
Cigna promotes a holistic approach to well-being. If you have these medical conditions, Cigna may provide additional dental services: heart disease, diabetes, maternity, head and neck cancer, stroke, chronic kidney disease and organ transplants.
1Frequency limitations apply.
2For West Virginia customers, 3-month waiting period applies to basic and major restorative services, and orthodontia. For New Jersey and Vermont customers, 6-month waiting period applies to major restorative services, and orthodontia. For Missouri and Rhode Island customers, waiting periods do not apply.
3The downloading and use of the myCigna.com mobile app is subject to the terms and conditions of the app and the online stores from which it is downloaded. Standard mobile phone carrier and data usage charges apply.
**Waived for preventive services
†Monthly rate is based on