Dental
We are proud to offer you a choice between three different dental plans.
With this plan, you choose a primary dental provider to manage your care. There are no charges for most preventive services, no claim forms and no deductibles. Reduced, pre-set charges apply to other services.
DHMO Schedule of Benefits (PDF)
| DHMO - Dental Rates | |
| Coverage | Employee Cost |
| Employee | $0.00 |
| Employee + Spouse | $9.92 |
| Employee + Child(ren) | $14.89 |
| Family | $27.37 |
This plan offers you the freedom and flexibility to use the dentist of your choice. However, you will maximize your benefits and reduce your out-of-pocket costs if you choose a dentist who participates in the Cigna network. If you receive in-network services, you will be responsible for any applicable cost sharing, negotiated charges after benefit maximums are met and costs for non-covered services.
Dental Plan Summary – Low Plan (PDF)
Cigna High and Low Plans Find a Dental Provider
| DPPO Low - Dental Rates | |
| Coverage | Employee Cost |
| Employee | $0.00 |
| Employee + Spouse | $27.08 |
| Employee + Child(ren) | $47.02 |
| Family | $82.46 |
This plan offers you the freedom and flexibility to use the dentist of your choice. However, you will maximize your benefits and reduce your out-of-pocket costs if you choose a dentist who participates in the Cigna network. If you receive out-of-network services, you will be responsible for any applicable cost sharing, charges in excess of the benefit maximum, charges in excess of the negotiated fee schedule amount and charges for non-covered services.
Dental Plan Summary – High Plan (PDF)
Cigna High and Low Plans Find a Dental Provider
| DPPO High - Dental Rates | |
| Coverage | Employee Cost |
| Employee | $0.00 |
| Employee + Spouse | $33.10 |
| Employee + Child(ren) | $58.86 |
| Family | $102.36 |
Dental Plan Highlights - In Network
| Benefits |
Low Plan (PPO) | High Plan (PPO) |
|---|---|---|
| Type I: Preventive Services Reimbursement Level X-rays Cleanings (2 per year) |
No waiting period See Low Plan summary (PDF) No deductible / 100% |
No waiting period See High Plan summary (PDF) No deductible / 100% |
| Type II: Basic Services Fillings Extractions Root canal |
$50 deductible / 80% | $50 deductible / 90% |
| Type III: Major Services Crowns Removable / fixed bridgework Partial or complete dentures |
$50 deductible / 50% | $50 deductible / 60% |
| Type IV: Orthodontia | Child Only $2,000 |
Child Only $2,000 |
| Annual Deductible |
||
| Individual | $50 | $50 |
| Family | $150 | $150 |
| Annual Maximum | ||
| Dental Annual Maximum | $2,000 | $2,000 |
| Orthodontia Lifetime Maximum | $2,000 | $2,000 |