Cigna Dental Preventive

When you mainly want coverage for dental check-ups, Cigna Dental Preventive is an affordable choice. Cigna pays 100 percent for cleanings, exams and routine x-rays¹ when you visit a Cigna Dental Preferred Provider Organization (DPPO) Advantage provider, and there are no deductibles or annual benefit maximums for these services.

With this flexible dental PPO plan, you can see any dentist, but you’ll be 100 percent covered for preventive and diagnostic services² when you choose from Cigna's national network of more than 89,000 dentists.*, **

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Benefits of All Cigna Dental Plans

Convenient billing and payments. Get your medical and dental insurance statements on one bill if you have Cigna for both.
No claim filling when you visit an in-network dentist. Cigna network dentists submit claims automatically.
No need to choose a primary dentist. And no referrals needed for specialist care.
Access to our national network of more than 89,000 dentists^*. Choose from in-network or out-of-network providers. Stay in-network to get the most benefits.
Where available, access to the Cigna Oral Health Integration Program^® for pregnant women and people with certain health conditions.
Digital tools for members, including the myCigna^® mobile app.⁶
24/7/365 live customer service, when and where you need it

Deductibles and Maximums

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

Preventive/Diagnostic Services

Benefit	DPPO Advantage Network	Out-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)³

Procedure	Frequency/Limitation⁴
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

Benefit	DPPO Advantage Network	Out-of-network
Basic Restorative Services Waiting Period	Not applicable	Not applicable
Basic Restorative Services (Fillings, non-routine x-rays)	You pay 100% of the provider's standard fee	You pay 100% of the provider’s standard fee

Procedure	Frequency/Limitation⁵
Fillings	Not covered under this plan.
Non-routine X-Rays	Not covered under this plan.
Routine Tooth Extraction	Not covered under this plan.
Emergency Treatment	Paid as a separate benefit only if no other service, except x-rays, is rendered during the visit

Major Restorative Services

Benefit	DPPO Advantage Network	Out-of-network
Major Restorative Services Waiting Period	Not applicable	Not applicable
Major Restorative Services⁵	You pay 100% of the provider's standard fee⁵	You pay 100% of the provider’s standard fee

Benefit

DPPO Advantage Network

Out-of-network

Major Restorative Services Waiting Period

Not applicable

Major Restorative Services⁵

You pay 100% of the provider's standard fee⁵

You pay 100% of the provider’s standard fee

Procedure	Frequency/Limitation⁴
Periodontal (Deep Cleaning)	Not covered under this plan.
Periodontal Maintenance	Not covered under this plan.
Crowns	Not covered under this plan.
Root Canal Therapy	Not covered under this plan.
Wisdom Tooth Extraction	Not covered under this plan.
Dentures and Partials	Not covered under this plan.
Bridges	Not covered under this plan.

Orthodontia

Benefit	DPPO Advantage Network	Out-of-network
Orthodontia Waiting Period	Not applicable	Not applicable
Orthodontia	You pay 100% of the provider's standard fee	You pay 100% of the provider’s standard fee
Orthodontia Individual Lifetime Maximum	Not applicable	Not applicable

Procedure	Frequency/Limitation
Orthodontia	Not covered under this plan.

State-Specific Details

Learn more about the benefits and coverage included in the Cigna Dental Preventive plan by selecting the state where you live:

All State Policy Disclosures, Exclusions, Limitations, and Reductions

This summary contains highlights only and is subject to change.

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†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, 2018.

¹Frequency limitations apply.

²Not all preventive services are covered, including athletic mouth guards. Refer to the policy for a complete list of covered and non-covered preventive services. Frequency limitations apply.

³For 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).

⁴For Maryland customers, please refer to the Summary of Benefits for Frequency/Limitation information.

⁵For AR, MN, NM, NV, and VT customers, coverage is provided for Temporomandibular Joint Dysfunction (TMJ) services, non-surgical, at 50% in network and out of network (plan deductible applies).

⁶The downloading and use of the myCigna® 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.

^*Data as of July 2017

^**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 page is not intended for residents of Georgia, New Mexico or West Virginia

Cigna Dental Preventive

Benefits of All Cigna Dental Plans

State-Specific Details

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