The dental PPO programme offers a large network of participating
providers in the Greater New York Metropolitan area and nationally.
A dental PPO functions like a medical PPO: the network of dentists who
participate in the CIGNA dental PPO plan accept as payment a fee schedule
negotiated with CIGNA. When covered services are rendered by an in-network
provider, CIGNA reimburses the dentist according to the schedule and
the participant normally has no out-of-pocket expense.
One may also choose a dentist who is not a participating
practitioner in the CIGNA plan. Covered dental services rendered by
out-of-network providers are reimbursed as a percentage of reasonable
and customary allowances as follows:
Diagnostic & Preventive Care: 90% after deductible,
Restorative Care: 80% after the deductible, or
Orthodontic care for children under age 19: 70%
after the deductible
Reimbursements are subject to an overall maximum of $2,250
per participant per programme year - 1 July through 30 June - except
that orthodontic services are subject to a separate, lifetime maximum
The premium rates and related percentages of salary contribution
are shown on the premium schedule..
It should be noted, that effective 1 July 2008,
anyone enrolled in the dental plan must continue to participate under the programme for the entire plan year.
Elections for discontinuation of coverage can only be made during the annual enrollment campaign.