Church Pension Group | Dental & Orthodontia PPO

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.

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