Basic Dental PPO
The Basic Dental PPO (DPPO) plan includes most preventive procedures at low or no cost to you, and these services are not subject to the annual maximum. However, you pay 15% coinsurance for basic restorative services and 50% coinsurance for major restorative services. These payments are subject to the annual maximum. Orthodontia is not covered under this plan.
The coverage includes:
- DPPO & Out-of-Network Annual Deductible: $50 individual, $150 family
- Annual Benefit Maximum: $2,000 individual
- Dental implants and medically necessary night guards are included as covered major services (plan pays 50%) and count towards the annual benefit maximum
- Preventive procedures are not subject to the annual benefit maximum.
| Service |
Your Cost |
|---|---|
|
Preventive & Diagnostic Services
|
DPPO Advantage Provider: 0% DPPO & Out-of-Network Provider: 0%1
|
|
Basic Restorative Services
|
DPPO Advantage Provider: 15% DPPO & Out-of-Network Provider: 15%1
|
|
Major Restorative Services
|
DPPO Advantage Provider: 50% DPPO & Out-of-Network Provider: 50%1
|
|
Orthodontia
|
Not covered under this plan
|
For detailed descriptions of our three dental plans, download our Cigna Dental Handbook.
View the plan summary:
1 If the provider’s fees exceed the regular and customary charges allowed in the plan, you may be billed for the balance.