What You Need To Know
Taking care of your teeth is important for your health and can help prevent certain diseases. Depending on where you live, you can choose from one of two Cigna dental plan options: the preferred provider organization (PPO) plan and the health maintenance organization (HMO) plan.
Preferred Provider Organization (PPO)
The Cigna Dental PPO plan pays for services provided by any dentist, but you’ll save more if you go to a Cigna network dental provider. You can still get benefits if you go outside the network, but you’ll end up paying more out of pocket.
Health Maintenance Organization (HMO)
With the Cigna Dental HMO plan, you can only receive care from a specific group of in-network HMO providers. There is no out-of-network coverage. To receive coverage, you must select a dental office within the HMO network, and all your dental care (including referrals to specialists in the network) will be coordinated by your chosen dental office. Each family member can choose their own dental office. With the Dental HMO, you don’t have to worry about deductibles, annual and lifetime dollar maximums, or claim forms.
If You Work in San Diego or the Imperial Valley, California
If you live in certain zip codes in San Diego or the Imperial Valley, California, you may be eligible to enroll in the SIMNSA dental plan. The providers covered under this plan are only available in Mexico.
For more details on the SIMNSA dental plan, review the Summary of Benefits Coverage (SBC) online through the Benefits Service Center website.
In-Network Benefits at a Glance
| Service | PPO Plan In-Network | PPO Plan Out-of-Network | HMO Plan |
|---|---|---|---|
| Annual deductible for basic and major services | $75 individual / $175 family | $75 individual / $175 family | No deductible |
| Preventive care (including routine exams, cleanings, X-rays) | Plan pays 100% | Plan pays 100%; subject to usual and customary limits | Plan pays 100%; copay may apply |
| Basic services (fillings, extractions, endodontics, periodontics) | Plan pays 20% after deductible | Plan pays 20% after deductible; subject to usual and customary limits | Refer to the Patient Charge Schedule for rates |
| Major services (inlays, onlays, crowns, dentures, bridges) | Plan pays 50% after deductible | Plan pays 50% after deductible; subject to usual and customary limits | Refer to the Patient Charge Schedule for rates |
| Dental implants | Not covered under plan | Not covered under plan | Refer to the Patient Charge Schedule for rates |
| Orthodontia services (covered for children under age 19 as clinically necessary) | Plan pays 50% after deductible $1,000 lifetime maximum benefit per person for both in- and out-of-network services | 50% coinsurance after deductible | Covers adults and children. Limited to 24 months. Refer to the Patient Charge Schedule for rates. |
| Annual maximum benefit | $2,000 combined annual maximum benefit per person | No maximum |
Pay for Care With Your HSA or FSA
Dental expenses not covered under the dental plan, like copays and deductibles, are eligible expenses under the health care FSA, the limited-purpose FSA and the health savings account (HSA). It’s a great way to use tax-free money to cover any eligible expenses you may have.
