Dental
Plan A: High Option
Plan A offers the highest level of dental coverage. This plan stresses preventive care to help you and your family avoid serious dental problems. The plan pays 100% of the covered cost (reasonable and customary charges) of preventive and basic services. It also pays 80% of the covered cost (reasonable and customary charges) of major services and orthodontia care. The maximum benefit you can receive under this plan each year is $2,000 per person.
Plan A also includes a Preferred Provider Organization (PPO) feature, which gives you the option of receiving care from PPO participating dental care providers and paying less out-of-pocket.
Participating dentists agree to charge negotiated rates. These rates are typically lower than the rates charged by non-participating dentists. This means that when you visit a participating dentist, your out-of-pocket costs may be less. Here’s an example of how you might save money using a participating dentist compared to a non-participating dentist.
Here’s an Example
Let’s assume you need a major procedure that’s covered at 80%:
Participating Dentist | Non Participating Dentist | |
Provider’s Regular Fee | $600 | $600 |
Negotiated Fee | $375 | N/A |
Reasonable & Customary Limit | 80% of $375 = $300 | 80% of $500= $400 |
You Pay | 20% of $375 = $75 | $200 ($600-$400 = $200) |
Savings obtained by using a participating provider: $125 |
NOTE: This chart is for illustrative purposes only.
To locate a participating provider in your area, visit www.cigna.com or call (800) 345-4511 to request a provider directory.
Click here to view Plan Option A Benefit Summary
REMINDER: Your member number is 000 + Your 6-digit Employee ID #.
Dental
Find a Dentist
Plan A: High Option
Plan B: Moderate Option
2024-2025 Dental Rates
What Is Covered
What Is Not Covered
Orthodontia
When Coverage Ends
When Coverage Ends for a Dependent Child
Glossary
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