Both Cigna PPO plans allow participants to choose any provider they wish and receive benefits. The covered benefits listed below apply to both in-network and out-of-network dental care for each plan. However, you generally pay less when you go to network dentist because dentists in the network have agreed to charge discounted fees.

Cleanings Per Year 4 4
(Deductible waived for preventive services)
$50/$150 $50/$150
Annual Maximum Benefit per member (progressive maximum) Year 1: $1,000

Year 2: $1,100

Year 3: $1,200

Year 4: $1,300

Year 1: $2,000

Year 2: $2,100

Year 3: $2,200

Year 4: $2,300

Preventive/Type A Coinsurance (cleanings) 100% covered 100% covered
Basic/Type B Coinsurance (fillings) 80% covered 80% covered
Major/Type C Coinsurance (crowns, dentures) 50% covered 50% covered
Orthodontia/Type D Coinsurance* N/A 50%
Orthodontics Lifetime Maximum*
(child and adult)
N/A $1,000
Reimburse % UCR 90th Percentile 90th Percentile

* Starting Jan. 1, 2024, orthodontia benefits will change to:

  • Dental PPO plan will add coverage for orthodontia services for dependents up to age 18 only, up to a lifetime maximum of $1,000 per covered participant.
  • Dental PPO Plus plan will be available to adults AND dependents up to age 18 and the lifetime maximum is increasing to $2,000 per covered participant.