Plan Overview
The DPPO Dental Plan has a preferred provider (PPO) network that offers a broad network of dentists to choose from and two tiers of in-network benefits: Cigna DPPO Advantage and Cigna DPPO.
The first tier, Cigna DPPO Advantage, offers the deepest discounts, greatest affordability and highest benefit level.
The second tier, Cigna DPPO, offers access to an expanded network of participating dentists at a reduced benefit level.
You also have the freedom to select an out-of-network dentist of your choice, but if you use a preferred provider dentist, you receive a higher level of coverage.
Watch: Cigna PPO Plan Overview video
Plan Coverage
Service Levels | Cigna DPPO Advantage (In-Network) | Cigna DPPO (In-Network) | Out of Network |
---|---|---|---|
Class 1 - Preventive & Diagnostic Care | 100% | 90% | 90% |
Class 2 - Basic Restorative Care | 80% | 70% | 70% |
Class 3 - Major Restorative | 60% | 50% | 50% |
Class 4 - Orthodontia | 50% | 50% | 50% |
Reimbursements paid to the dentist by Cigna | Contracted Rates - No Balance Billing of outstanding charges | 80% of Reasonable and Customary Charges + any balance not paid by Cigna |
The plan has a $50 individual plan year deductible (no deductible for in-network preventive cleanings) before any payment will be made, $150 maximum deductible per family and a $1,500 plan year maximum benefit. Members who receive a preventive cleaning will have their annual maximum benefit increase by $200 the following plan year. Orthodontia coverage is available for dependent children younger than 19. The lifetime maximum orthodontia benefit is $1,500 for each covered dependent child.
The Cigna dental plan is structured to include both in-network and out-of-network benefits. In-network benefits apply if you use a PPO dentist; out-of-network benefits apply for non-PPO dentists.
Monthly Premiums - Fiscal Year 2024-25
Election | Full-Time Employee Pays |
---|---|
Employee Only | $5.46 |
Employee & Spouse/Partner | $51.46 |
Employee & Children | $36.12 |
Employee & Family | $82.16 |
View premiums for retirees and COBRA participants.