The Cigna Dental Oral Health Integration Program® is a program that reimburses out-of-pocket costs for specific dental services used to treat gum disease and tooth decay.
The program is for people with certain medical conditions that have been found to be associated with gum disease. There's no additional cost for the program – if you qualify, you get reimbursed!1
Do I Qualify?
If you have a Cigna dental plan, you’re eligible for the program. You do not have to be enrolled in a Cigna medical plan to be eligible for this program. You must currently be under treatment by a doctor for any of the following conditions:
- Heart disease
- Chronic kidney disease
- Organ transplants
- Head and neck cancer radiation
How does it work?
First, before visiting your dentist, you must enroll in the program by completing and mailing the program registration form.
When you visit your dentist, you will pay your usual deductible, copay or coinsurance amount. As a reminder, your copay is the fixed amount you pay for covered services, and your coinsurance is the percentage of costs you pay for covered services.
Next, your dentist will send Cigna a claim. We review the claim and will refund your out-of-pocket costs for eligible dental services. Once we receive your claim, you can expect to be reimbursed in about 30 days.
What dental services are covered under the Cigna Dental Oral Health Integration Program?
Check the chart below to see which dental services1 are covered for each qualifying medical condition.
|Heart Disease||Stroke||Diabetes||Maternity||Chronic Kidney Disease||Organ Transplants||Head and Neck cancer radiation|
|Periodontal Treatment & Maintenance (D4341, D4342, D49102)||Yes||Yes||Yes||Yes||Yes||Yes||Yes|
|Periodontal Evaluation (D0180)||No||No||No||Yes||No||No||No|
|Oral Evaluation (D01203, D01403, D01503)||No||No||No||Yes||No||No||No|
|Scaling in the presence of inflammation - Full Mouth (D43464)||No||No||No||Yes||No||No||No|
|Emergency Palliative Treatment (D91105)||No||No||No||Yes||No||No||No|
|Topical application of fluoride & Topical application of fluoride varnish (D12066)||No||No||No||No||Yes||Yes||Yes|
|Topical application of fluoride - excluding varnish (D12086)||No||No||No||No||Yes||Yes||Yes|
|Sealant Repair - per tooth (D1353 6)||No||No||No||No||Yes||Yes||Yes|
How do I enroll?
- Fill out the registration form [PDF]. You can also call the number on your Cigna ID card to have an enrollment form sent to you. You only need to complete the form one time per qualifying condition.
- Mail in your completed form to:
P.O. Box 188037
Chattanooga, TN 37422
- You will receive a welcome letter in the mail once you've been enrolled.
Once you're enrolled, you can visit your dentist and pay your usual deductible, copay or coinsurance amount for the covered service. We'll send your reimbursement in about 30 days.
Please note that services received prior to enrollment are not eligible for reimbursement.
Oral Health Integration Program Frequently Asked Questions
What else does the Oral Health Integration Program include?
When you join the program, you get discounts on prescribed mouthwashes, fluoride gels, and toothpastes from your dentist through Cigna Home Delivery Pharmacy who will help you get these items sent right to your home.7 You can ask us for information on issues that affect your oral health and your overall wellness – such as fear of going to the dentist. Or the effect of stress or tobacco products. We'll also give you guidance on how to overcome these behaviors.
What are Periodontal Treatment and Maintenance?
Periodontal treatment and maintenance are not the same as prophylaxis or "regular cleaning." Periodontal treatment (or "scaling and root planing") consists of "deep cleaning" which involves parts of your teeth below the "gum line." During scaling and root planing, the dentist may numb the area of your mouth that they are working on. Periodontal maintenance is a follow-up procedure involving removal of plaque and calculus (tartar) above and below the gum line along with scaling and root planing in areas where needed.
Do I have to enroll in the program each time I go to the dentist?
You need to enroll in the program once for each eligible medical condition. Once enrolled, Cigna will automatically reimburse you for the dental services covered for that medical condition.
How and when will I get reimbursed for my out-of-pocket expenses?
As with any dental service, you will pay your dentist at the time the service is performed. A claim form is typically submitted to Cigna by your dentist. Once we receive the claim form from the dentist, we pay them for their services and you will then receive reimbursement for the amount of your deductible, copay or coinsurance. This may take about 30 days, depending on when the dentist submits the claim. Please keep in mind that only dental services eligible under the Cigna Dental Oral Health Integration Program will be reimbursed.
How do I know if my enrollment has been processed?
Once your enrollment has been approved, Cigna will send you a program welcome letter or email.
If my dental coverage has a calendar year maximum or deductible, how do procedures covered under the program get applied?
Any procedures covered under the program are not subject to or applied toward your plan's annual deductible. However, they are applied towards and subject to your plan's calendar year maximum.
If I go out-of-network, will the services covered under this program still apply?
If your plan does not include coverage for out-of-network services, then you must use a dentist in your plan's network for coverage under this program to apply. If your plan includes out-of-network coverage, you will be reimbursed for your covered expenses whether you choose to use an in-network or out-of-network dentist. However, if you use an out-of-network dentist you may have out-of-pocket costs because the dentist may choose to bill you for charges that are in excess of what your plan reimburses for covered expenses.
If I'm a dependent (spouse, partner or child), do I provide my ID number or the person who is the primary covered individual?
Please provide the ID number of the person who is the primary covered individual.
Where can I find my Group/Account Number?
Please check a previous Explanation of Benefits, your dental page on myCigna®, or call Customer Service at the number on your ID card and follow the prompts to get your Group/Account Number. You can also provide your ID and/or social security number and a Customer Service Representative will identify your Group/Account Number for you. If you have a Cigna Medical or Dental ID card the Group/Account Number is listed on the cards.
What does "Other Coverage" mean, on the registration form?
Please complete the Other Coverage section of the form if you have additional coverage through a different carrier (sometimes referred to as “secondary insurance”), typically through your spouse or partner.
If I don't have an e-mail address but still want information on discounted prescription products, discounted non-prescription products or information on behavioral conditions affecting my oral health, how can I get the information?
Please include a note when you submit your Cigna Dental Oral Health Integration Registration Form indicating the address where you would like the information mailed and it will be sent through the U.S. Postal Service.
Do I have to include anything that proves I have a condition and does Cigna have the right to verify my condition?
You do not have to include any documentation with your registration form that proves you have a specific condition. However, at the bottom of the form you must sign your name verifying that you have the condition and acknowledge that Cigna reserves the right to request medical records or check with your physician prior to reimbursement.
If I have questions about the Cigna Dental Oral Health Integration Program or how to complete and submit the registration form who do I call?
Please call Customer Service at the number on your Cigna ID card with any questions. One of our associates will be happy to help you, 24 hours a day, seven days a week.
1Eligibility, reimbursement and coverage for eligible services are subject to applicable calendar year maximums. Participation in the program does not guarantee coverage and is subject to the terms of your plan documents. Some employers may have opted-out from offering this program. If you have dental coverage through your employer, review your plan documents for details.
2Limited to four times per year and subject to plan guidelines.
3One additional evaluation per year.
4One additional cleaning per year.
6Age limits removed, all other limitations (including frequency limitations) apply. Refer to your plan documents for the details of your specific plan.
7Pharmacy discounts are available through Cigna Home Delivery Pharmacy only. This is a discount and is NOT insurance. This discount is separate from your dental benefits and you are required to pay the entire discounted charge. You should check any insurance or other benefits you have before using these discounts, as those benefits may result in lower costs to you. The Cigna Dental Oral Health Integration Program may not be available under your specific plan. Reimbursement under this program 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 representative or see your plan documents.