Individual | Family
Annual Benefit Maximum
Individual | Family
Lifetime Individual Orthodontia Deductible
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.
It's easier to manage your dental care with:
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.
2The 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.
|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 prophy or perio maintenance procedure per consecutive 6-month period (routine prophy is Class I; perio prophy is Class II)|
|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 younger than age 14|
|Sealants||1 treatment per tooth per lifetime. Payable on unrestored permanent bicuspid or molar teeth only up to 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|
|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||Root canal re-treatment 1 per 24 consecutive months, if necessity demonstrated|
|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||Covered if more than 12 months after installation; 1 per 36 consecutive months|
|Adjustments||Covered if more than 12 months after installation; 1 per 12 consecutive months|
|Repairs — Bridges and Dentures||Covered if more than 12 months after installation|
|Dentures and Partials||Replacement limited to 1 per 84 consecutive months, if unserviceable and cannot be repaired.|
|Bridges||Replacement limited to 1 per 84 consecutive months, if unserviceable and cannot be repaired. Benefits are based on the amount payable for non-precious metals. No porcelain or white/tooth-colored material on molar crowns or bridges|
|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.
per person, per month