Dental

Plan B: Moderate Option

Plan B offers a moderate 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 services. It also pays 80% of the covered cost (reasonable and customary charges) of basic restorative services, and 50% of major services and orthodontia care. The maximum benefit you can receive under this plan each year is $1,500 per person in-network, or $1,000 out of network. Orthodontia carries a separate $1,500 lifetime maximum in-network.

Plan B 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 50%:

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.

Plan Option B Benefit Summary:

*PDP Fee refers to the fees that participating PDP dentists have agreed to accept as payment in full.

**Reasonable & Customary charges are based on the research of a dentist’s usual, actual & community average charge as determined by Cigna.

***Applies only to Type B & C Services.