Preventive Dental PPO
The Preventive 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. You pay 20% coinsurance on basic restorative services and 99% coinsurance on major restorative services, which are subject to the annual maximum.
The coverage includes:
- DPPO Advantage, DPPO, & Out-of-Network Annual Deductible: $0 individual, $0 family
- Annual Benefit Maximum: $1,500 individual
- Sealants will be included up to age 14 as a covered preventive service (plan pays 100%)
- 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: 20% DPPO & Out-of-Network Provider: 20%1
|
|
Major Restorative Services
|
DPPO Advantage Provider: 99% DPPO & Out-of-Network Provider: 99%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.