2014 Dental Insurance: myCigna Dental Preventive Plan Details

  • Annual Deductible
    $0* Individual | $0* Family
  • Annual Benefit Maximum
    $0* Individual
  • Lifetime Individual Orthodontia Deductible
    Not Covered
  • From
    $17
  • per person, per month

Benefit In-network Out-of-network
Individual Annual deductible Covers preventive services only with no deductible Covers preventive services only with no deductible
Family Annual deductible Covers preventive services only with no deductible Covers preventive services only with no deductible
Annual Benefit Maximum No annual maximum for preventive services No annual maximum for preventive services
Separate lifetime Individual Orthodontia Deductible Orthodontia not covered Orthodontia not covered
Benefit In-network Out-of-network
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% You pay 0% (for North Carolina, you pay 5%)
Procedure*Frequency/Limitation
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
*For Maryland customers, please refer to Summary of Benefits for Frequency/Limitation information.
Benefit In-network Out-of-network
Basic Restorative Services Waiting Period Does not apply Does not apply
Basic Restorative Services (Fillings, non-routine x-rays) In-network discounts apply You pay 100% Not covered
Procedure*Frequency/Limitation
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 Maryland customers, please refer to Summary of Benefits for Frequency/Limitation information.
Benefit In-network Out-of-network
Major Restorative Services Waiting Period Does not apply Does not apply
Major Restorative Services
In-network discounts apply
You pay 100% Not covered
Procedure*Frequency/Limitation
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 Maryland customers, please refer to Summary of Benefits for Frequency/Limitation information.
Benefit In-network Out-of-network
Orthodontia Waiting Period Does not apply Does not apply
Orthodontia
In-network discounts apply
You pay 100% Not covered
Orthodontia Individual Lifetime Maximum Orthodontia not covered Orthodontia not covered
ProcedureFrequency/Limitation
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 want basic coverage…

Your family is healthy, and your teeth are too! You mainly want coverage for yearly checkups because you know healthy teeth can lead to better overall health. Whether you’re a single person—or have a family—this plan may be right for you. Your low monthly premium ensures that Cigna pays for all your annual dental visits.

  • No individual or family deductible, which means Cigna pays 100% in-network preventive and diagnostic services, including cleanings, exams and routine x-rays.1
  • No waiting period for preventive or diagnostic services, once your plan is effective. No annual maximum for preventive services. You’re 100% covered all year.
  • Discounts for restorative and orthodontia services (in many states), so your costs are reduced if someone needs more extensive dental work. That includes crowns, bridges fillings, root canals and dentures.

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.

 

With every Cigna Dental 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.
  • 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 your bills and claims online, anytime—and pay your bills online, too.
  • Mobile access on the go. Find a dentist, check coverage and show your ID card with the myCigna Mobile app.2

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.

*Preventive services only.
**Waived for preventive services
Monthly rate is based on