Dental Insurance: Cigna Dental Preventive Plan Details

  • Calendar Year Deductible
    $0* Individual | $0* Family
  • Calendar Year Benefit Maximum
    $0* Individual
  • Lifetime Individual Orthodontia Benefit
    Not Applicable
  • From
    $17
  • per person, per month

Benefit DPPO Advantage Network Out-of-network
Individual Calendar Year Deductible Not Applicable Not Applicable
Family Calendar Year Deductible Not Applicable Not Applicable
Calendar Year Benefit Maximum Not Applicable Not Applicable
Separate lifetime Individual Orthodontia Deductible Not Applicable Not Applicable
Benefit DPPO Advantage NetworkOut-of-network
Preventive/Diagnostic Services Waiting Period Not Applicable Not Applicable
Preventive Diagnostic Services (Oral exams, cleanings, x-rays, fluoride application, sealants, non-orthodontic space maintainers) You pay 0% You pay the difference between the provider’s standard fee and 100% of the Maximum Allowable Charge (MAC)*
ProcedureFrequency/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 North Carolina customers: You pay the difference between the provider’s standard fee and 95% of the Maximum Allowable Charge (MAC)

For Massachusetts and Alaska customers: You pay the difference between the provider’s standard fee and 100% of the Maximum Reimbursable Charge (MRC)

**
For Maryland customers, please refer to the Summary of Benefits for Frequency/Limitation information.
Benefit DPPO Advantage NetworkOut-of-network
Basic Restorative Services Waiting Period Not Applicable Not Applicable
Basic Restorative Services (Fillings, non-routine x-rays) In-network discounts apply You pay 100% of the provider’s contracted fee* You pay 100% of the provider’s standard fee
ProcedureFrequency/Limitation**
Fillings Not covered under this plan. Discounts may apply*
Non-routine X-Rays Not covered under this plan. Discounts may apply*
Routine Tooth Extraction Not covered under this plan. Discounts may apply*
Emergency Treatment Paid as a separate benefit only if no other service, except x-rays, is rendered during the visit
*

Cigna DPPO Advantage Network providers contracted with Cigna may pass along contracted fees, which may be considered a discount. (Discounts are not available in Maryland, New York and Virginia. For these states you pay 100% of the provider’s standard fee).

**
For Maryland customers, please refer to the Summary of Benefits for Frequency/Limitation information.
Benefit DPPO Advantage Network Out-of-network
Major Restorative Services Waiting Period Not Applicable Not Applicable
Major Restorative Services*
In-network discounts apply
You pay 100% of the provider’s contracted fee*
You pay 100% of the provider’s standard fee
ProcedureFrequency/Limitation***
Periodontal (Deep Cleaning) Not covered under this plan. Discounts may apply.***
Periodontal Maintenance Not covered under this plan. Discounts may apply.***
Crowns Not covered under this plan. Discounts may apply.***
Root Canal Therapy Not covered under this plan. Discounts may apply.***
Wisdom Tooth Extraction Not covered under this plan. Discounts may apply.***
Dentures and Partials Not covered under this plan. Discounts may apply.***
Bridges Not covered under this plan. Discounts may apply.***
*
For MN, NM and NV customers, coverage is provided for Temporomandibular Joint Dysfunction (TMJ) services, non-surgical, at 50% in network and out of network.
**
For Maryland customers, please refer to the Summary of Benefits for Frequency/Limitation information.
***
Cigna DPPO Advantage Network providers contracted with Cigna may pass along contracted fees, which may be considered a discount. (Discounts are not available in Maryland, New York and Virginia. For these states: You pay 100% of the provider’s standard fee).
Benefit DPPO Advantage NetworkOut-of-network
Orthodontia Waiting Period Not Applicable Not Applicable
Orthodontia
In-network discounts apply
You pay 100% of the provider’s contracted fee* You pay 100% of the provider’s standard fee
Orthodontia Individual Lifetime Maximum Not Applicable Not Applicable
ProcedureFrequency/Limitation**
Orthodontia Not covered under this plan. Discounts may apply.*
*
Cigna DPPO Advantage Network providers contracted with Cigna may pass along contracted fees, which may be considered a discount. (Discounts are not available Maryland, New York and Virginia. For these states: You pay 100% of the provider’s standard fee).
**
For Maryland customers, please refer to the Summary of Benefits for Frequency/Limitation information.

You may pay more for out-of-network charges if the dentist’s charges exceed the amount Cigna reimburses for billed services.

This summary contains highlights only and is subject to change.

This website is not intended for New Mexico residents.

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 lower monthly premium ensures that Cigna pays for your annual dental visits.

  • No individual or family deductible, which means Cigna pays 100% preventive and diagnostic services when you visit a Cigna DPPO Advantage provider, including cleanings, exams and routine x-rays.1
  • No waiting period for preventive or diagnostic services, once your plan is effective. No calendar year maximum for preventive services. You’re 100% covered all year when you visit a Cigna DPPO Advantage provider.1,2
  • 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. Cigna Dental plans may provide additional dental services through the Cigna Oral Health Integration Program®* if you have any of the following qualifying medical conditions: heart disease, diabetes, maternity, head and neck cancer, stroke, chronic kidney disease and organ transplants.

*
The Oral Health Integration Program (OHIP) may not be available in all areas. Reimbursement under OHIP is subject to dental plan terms and conditions, including applicable annual benefit maximums and other exclusions and limitations. For costs and details of coverage, see your plan documents or contact your Cigna representative.

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.
  • 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
1
Frequency limitations apply.
2
Not all preventive services are covered, including athletic mouth guards. Refer to your policy for a complete list of covered and non-covered services.
3
The downloading and use of the myCigna.com mobile app is subject to the terms and conditions of the app and the online store 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 a single person and represents Cigna's national average rate for each plan using an average age. Valid through December 31, 2015.