Cigna Dental PPO

 

Dental PPO

Plan Outline

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, or
  • 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 of $2,250.

Premium

The premium rates and related percentages of salary contribution are shown on the premium schedule.

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Benefits

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.