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Your Dental Insurance
How the Dental Plan Works (PPO)
The Premier and Standard dental plans are "passive" Preferred
Provider Organization (PPO) plans. That means you may use any dentist
you wish, or you may see a dentist who participates in the Preferred
Provider network. If you choose to use participating dentists, the
plan covers a higher percentage of eligible expenses, and your out-of-pocket
costs are lower. For a complete list of participating dentists,
see a Benefits Counselor or visit the CIGNA
web site.
The Dental Plan pays benefits for four types of services:
For each type of service, benefits are paid according
to reasonable and customary (R&C) fees. R&C fees are the
amounts charged by other dentists in your community for similar
services and supplies. You pay any amount over the insurance company's
R&C portion of the payment.
Although the PPO dental plans cover preventive care
at 100%, there are differences between the two plans. The CIGNA
Standard Dental PPO Plan has lower per paycheck contributions than
the CIGNA Premier Dental PPO Plan, but higher out-of-pocket costs.
The CIGNA Standard Dental PPO Plan has an annual deductible
that you must meet before the plan begins paying for non-preventive
services. The CIGNA Premier Dental PPO Plan offers higher levels
of coverage for most dental services than the CIGNA Standard Dental
PPO Plan, and includes coverage for orthodontia and implants. See
the comparison chart of the dental plans.
The following sections contain highlights of the four
types of services.
Preventive Services
Many dental expenses result from problems that could
have been prevented by regular checkups. The Dental Plan helps you
avoid these expenses by paying for preventive and diagnostic services.
- Routine oral exams, cleaning, and scaling
of teeth (twice per calendar year)
- Single x-rays and series of bitewing x-rays
- Full-mouth x-rays (not more than once every
36 months)
- Fluoride treatments for children under 19
(once per calendar year)
- Fixed space maintainers
Basic Services
- Oral surgery (other than procedures for which
Health Plan benefits are payable), including such procedures as
simple and surgical extractions
- Administration of general anesthetics, when
performed in connection with oral surgery
- Fillings
- Root canal therapy (treatment of the pulp
of a tooth)
- Repair or re-cementing of bridgework and
dentures
- Treatment of gums and other tissues of the
mouth
- Apicoectomy (surgically removing the tip
of the tooth root)
Major Services
- Major restorative services, such as gold
inlay fillings and porcelain or cast gold crowns
- Prosthodontics (artificial replacement of
natural teeth, including complete and partial dentures and bridges)
- Implants (Premier PPO only)
Orthodontic Services
Orthodontia involves teeth straightening and repositioning.
- A preliminary study consisting of radiographs,
diagnostic casts, and a treatment plan
- The first month of active orthodontic treatment,
including appliances such as braces
- Covered monthly expenses for visits to the
orthodontist and braces after the first month
DHMO FAQ (81 KB PDF)
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