Dental & Orthodontia PPO
The Dental & Orthodontia PPO (DPPO) plan includes most preventive procedures at low or no cost to you. Preventive procedures are not subject to the annual maximum. You pay 15% coinsurance on basic and major restorative services, which are subject to the annual maximum, and 50% coinsurance on orthodontia services subject to the lifetime orthodontia maximum.
The coverage includes:
- DPPO and Out-of-Network Annual Deductible: $25 individual, $75 family
- Annual Benefit Maximum: $2,000 individual
- Lifetime Orthodontic Maximum: $1,500 individual
- Dental implants and medically necessary night guards are included as covered major services (plan pays 85%) 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: 15% DPPO & Out-of-Network Provider: 15%1
|
|
Orthodontia
|
DPPO Advantage Provider: 50% DPPO & Out-of-Network Provider: 50% (up to the $1,500 separate lifetime maximum)1
|
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.