|Dental Coverage That Fits|
|Cigna Dental Care DHMO1||Monthly Rates
Employee Only $9.04
Employee + Dependent $14.18
Employee + 2 or More Dependents $22.40
Regular dental care is important for a healthy smile. And a healthy body. With Cigna Dental Care® DHMO, you get comprehensive dental coverage that's easy to use. At a wallet-friendly price. Now that's something to smile about.
This overview shows you a sampling of covered services. And your estimated costs with - and without - coverage. For a full listing of covered services, please call Customer Service at 800.Cigna24 (800.244.6224).
Get the most value from your plan
With your Cigna DHMO plan, some preventive services are covered at no extra cost to you. (See below.) Your plan also covers many other dental services that can help your mouth stay healthy.
Your Cigna DHMO plan is a copayment plan. Here's how it works. When you get a dental service, Cigna allows your network dentist to charge a certain amount. Then you pay a fixed portion of that cost. And your plan pays the rest. There are no annual maximums and no deductibles!
Review your plan materials for more information about how your plan works. If you have questions before enrollment, call 800.Cigna24 (800.244.6224) and select the "Enrollment Information" prompt.
|WHAT YOU'LL PAY2|
|Sampling of covered procedures||With Cigna Dental Care||Without Dental Coverage|
|Adult Cleaning (two per calender year - each at $0) (additional cleanings available at $45 each)||$0||$69 - $139 each|
|Child Cleaning (two per calender year - each at $0) (additional cleanings available at $30 each)||$0||$69 - $139 each|
|Periodic oral evaluation||$0||$40 - $81|
|Comprehensive oral evaluation||$0||$62 - $126|
|Topical flouride (two per calender year - each at $0) (additional topic flouride available at $15 each)||$0||$28 - $57|
|X-rays - (bitewings) 2 films||$0||$32 - $66|
|X-rays - panoramic film||$0||$83 - $168|
|Sealant - per tooth||$17||$41 - $84|
|Amalgam fillings (silver colored - 2 surfaces)||$22||$116 - $237|
|Composite filling (tooth - colored) - 1 surface, Anterior||$22||$119 - $241|
|Molar root canal (excluding final restoration)||$530||$847 - $1,720|
|Comprehensive orthodontic treatment of the adolescent detention - Banding||$515||$987 - $2,004|
|Periodontal (gum) scaling & root planning - 1 quardrant||$115||$181 - $367|
|Periodontal (gum) maintenance||$78||$107 - $217|
|Removal / extraction of erupted tooth||$53||$123 - $250|
|Removal / extraction of impacted tooth - completely bony||$230||$366 - $743|
|Crown - porcelain fused high noble metal||$470||$845 - $1,717|
|Implant supported retainer for porcelain fused to metal fixed partial denture||$770||$1,200 - $2,437|
|Occlusal appliance, by report (for treatment of TMJ)||$455||$632 - $1,284|
Offered by: Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company or their affiliates.
You can save money on a wide range of services, including:
Visit Cigna.com to find a network general dentist.
Call 800.Cigna24 (800.244.6224) to speak with a customer service representative. You can ask for a customized dental directory to be sent to you via email.
* Coverage for treatment by a pediatric dentist ends on your child's 7th birthday. Effective on your child's 7th birthday, dental services generally must be obtained from a network general dentist.
|Oral evaluations||Oral evaluations are limited to a combined total of 4 of the following evaluations during a 12 consecutive month period: Periodic oral evaluation (D0120), comprehensive oral evaluations(D0150), compreghensive periodonal evaluations (D0180) ,and oral evaluations for patients under 3 years of age (D0145)|
|X-rays (routine)||Bitewings: 2 per calender year|
|X-rays (non-routine)||Full mouth: 1 every 3 calender years
Panorex: 1 every 3 calender years
|Periodontal root planning and scaling||Limit 4 quadrants per consecutive 12 months|
|Periodontal maintenence||Limited to 4 per year and (only covered after active periodontal therapy)|
|Crowns and inlays||Replacement 1 every 5 years|
|Bridges||Replacement 1 every 5 years|
|Dentures and partials||Replacement 1 every 5 years|
|Orthodontic treatment||Maximum benefit of 24 months of interceptive and / or comprehensive treatment. Atypical cases or cases beyond 24 months require an additional payment by the patient|
|Relines, rebases||One every 36 months|
|Denture adjustments||Four within the first 6 months after intallation|
|Prosthesis over implant||Replacement 1 every 5 years if unserviceable and cannot be repaired|
|Temporomandibular Joint (TMJ) treatment||One occlusal orthotic device per 24 months|
|Athletic mouth guard||One athletic mouth guard per 12 months|
|General anesthesia / IV sedation||General anesthesia is covered when performed by an oral surgeon when medically necessary for covered procedures listed on the PCS. IV sedation is covered when performed by a periodontist or oral surgeon when medically necessary for covered procedures listed on the PCS. Plan limitation for this benefit is 1 hour per appointment|
Specialty treatment plans require payment authorization for services to be covered. Before treatment starts, you should verify with your network specialty dentist that your treatment plan has been authorized for payment by Cigna
If any law requires coverage for any particular service(s) noted above, the exclusion or limitation for that service(s) does not apply.
This document outlines the highlights of your plan. For a complete list of both covered and non-covered services, including benefits required by your state, see your insurance certificate or plan description. If there are any differences between the information contained here and the plan documents, the information in the plan documents takes precedence.
1. The term "DHMO" is used to refer to product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans, managed care plans, and plans with open access features.
The Cigna DHMO is not available in the following states: AK, HI, ME, MT, NH, NM, ND, PR, RI, SD, VT, WV, and WY.
2. Costs listed for the Cigna Dental Care plan do not vary. Estimated costs without dental coverage may vary based on location and dentists' actual charges. These estimated costs are based on charges submitted to Cigna in 2014/2015 and are intended to reflect national average charges as of July 2016 assuming an annual cost increase of three percent. Estimates have been adjusted to reflect the 2015 Cigna DHMO geographical membership distribution. Office visit fee may also apply.
3. This is NOT insurance and does not provide for reimbursement of financial losses. Cigna's Identity Theft services are provided under a contract with Europ Assistance USA. Full terms are contained in Cigna's Identity Theft Program service agreement.
4. Minnesota residents: You must visit your selected network dentist in order for the charges on the Patient Charge Schedule to apply. You may also visit other dentists that participate in our network or you may visit dentists outside the Cigna Dental Care network. If you do, the fees listed on the Patient Charge Schedule will not apply. You will be responsible for the dentist's usual fee. We will pay 50% of the value of your network benefit for those services. Of course, you'll pay less if you visit your selected Cigna Dental Care network dentist. Call Customer Services for more information. Oklahoma residents: DHMO for Oklahoma is an Employer Group Pre-Paid Dental Plan. You may also visit dentists outside the Cigna Dental Care network. If you do, the fees listed on the Patient Charge Schedule will not apply. You will be responsible for the dentist's usual fee. We pay non-network dentists the same amount we'd pay network dentists for covered services. Of course, you'll pay less if you visit a network dentist in the Cigna Dental Care network. Call Customer Services for more information.
5. California and Texas residents: Treatment for conditions already in progress on the effective date of your coverage are not excluded if otherwise covered under you PCS. Dentists who participate in Cigna's network are independent contractors solely responsible for the treatment provided and are not agents of Cigna.
|Vision Network Savings Program1 powered by Cigna Vision|
|Plan #: 9234030|
|ROUTINE VISION CARE SERVICES||CUSTOMER COST3|
|Routine vision examination:
Including but not limited to eye health examination, dilation, refraction and prescription for glasses
$5 off routine exam
|Standard clear plastic or glass lenses:
Up to $50
Up to $75
Up to $105
Standard UV coating
Standard anti-reflective coating
Other add-ons and services
Up to $15
Up to $15
Up to $40
Up to $45
Retailers such as:
JC Penney Optical, Sears Optical, Target Optical, Pearle Vision and Visionworks
25% off retail prices on frames
40% off retail prices on most frames3
|Contact lenses and professional services:
Contact lens professional services (fitting and evaluation)
$10 off contact lens exam
Check with your Cigna Vision network eye care professional for any available offers on contact lenses.
|Non-Prescription Sunglasses2||20% savings|
Exam and Materials
The Cigna Vision network offers over 25,000 locations nationwide, including these national retail opticals:
These discounts are only available through a Cigna Vision network eye care professional. Stated discounts cannot be used in conjunction with other discounts, promotions or prior orders. Network eye care professionals are independent contractors solely responsible for your routine vision examinations and products.
1. The Cigna Vision Network Savings program offered through Healthy Rewards is a discount program. Some programs are not available in all states and programs may be discontinued at any time. If your Cigna plan includes coverage for any of these services, this program is in addition to, not instead of, your plan coverage. Discount programs are separate from plan benefits. A discount program is NOT insurance, and you must pay the entire discounted charge directly to the participating eye care provider.
2. Provider participation is 100% voluntary. Please check with your eye care professional for any discount offer.
3. Select frames may not be available for savings.
4. Regional pricing and availability may vary depending on your location. Check with your Cigna Vision network eye care professional for details.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
830501 c 05/15 © 2015 Cigna. Some content provided under license.