How do I find a dentist?What services are covered?Can my kids get braces?
Network Options: PPO Network
Check to see if your current dentist is a participating network dentist:
- Click on “Find a Doctor, Dentist or Facility” at the top of the page
- Choose “Plans through your employer or school”
- Choose Cigna Dental PPO network
- Enter your search criteria
(800) 244-6224 | mycigna.com
Dental Plan
Cigna PPO Low Plan
In-Network
Out-of-Network*
Annual Deductible
January 1 - December 31
January 1 - December 31
$50 per individual
$150 per family
$150 per family
Annual Maximum
January 1 - December 31
January 1 - December 31
$1,000 per individual
Preventive Services
Cleanings, routine exams, fluoride, and x-rays
Cleanings, routine exams, fluoride, and x-rays
You pay 0% for covered services,
Deductible Waived
Deductible Waived
You pay 20% of R&C, AD
Deductible Waived
Deductible Waived
Basic Services
Fillings, sealants, extractions, scaling & root planing, space maintainers, and bridge & crown maintenance
Fillings, sealants, extractions, scaling & root planing, space maintainers, and bridge & crown maintenance
You pay 20% AD
You pay 30% of R&C, AD
Major Services
Crowns, bridges, implants, dentures, inlays, onlays, veneers, general anesthesia, endodontics, and periodontics
Crowns, bridges, implants, dentures, inlays, onlays, veneers, general anesthesia, endodontics, and periodontics
You pay 60% AD
You pay 60% of R&C, AD
Orthodontic Services
Children under age 19
Children under age 19
Not Covered
Orthodontic Lifetime Maximum
Not Covered
AD: After Deductible
R&C: Reasonable & Customary fee.
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2021 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
R&C: Reasonable & Customary fee.
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2021 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Employee Cost Per Pay Period
Employee Only
$13.24
Employee + Spouse
$21.55
Employee + Child(ren)
$27.00
Employee + Family
$41.26
Cigna PPO High Plan
In-Network
Out-of-Network*
Annual Deductible
January 1 - December 31
January 1 - December 31
$50 per individual
$150 per family
$150 per family
Annual Maximum
January 1 - December 31
January 1 - December 31
$1,500 per individual
Preventive Services
Cleanings, routine exams, fluoride, and x-rays
Cleanings, routine exams, fluoride, and x-rays
You pay 0% for covered services,
Deductible Waived
Deductible Waived
You pay 20% of R&C, AD
Deductible Waived
Deductible Waived
Basic Services
Fillings, sealants, extractions, scaling & root planing, space maintainers, and bridge & crown maintenance
Fillings, sealants, extractions, scaling & root planing, space maintainers, and bridge & crown maintenance
You pay 20% AD
You pay 30% of R&C, AD
Major Services
Crowns, bridges, implants, dentures, inlays, onlays, veneers, general anesthesia, endodontics, and periodontics
Crowns, bridges, implants, dentures, inlays, onlays, veneers, general anesthesia, endodontics, and periodontics
You pay 50% AD
You pay 50% of R&C, AD
Orthodontic Services
Children under age 19
Children under age 19
Plan pays up to 50% AD
Plan pays up to 50% of R&C, AD
Orthodontic Lifetime Maximum
$1,500 per individual
AD: After Deductible
R&C: Reasonable & Customary fee.
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2021 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
R&C: Reasonable & Customary fee.
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
This information is designed to help you choose a benefit plan for 2021 only. Please refer to the Plan Documents provided by the carrier for information regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
Employee Cost Per Pay Period
Employee Only
$21.74
Employee + Spouse
$41.20
Employee + Child(ren)
$51.60
Employee + Family
$78.85
