| Service | Cigna DPPO In-Network |
Cigna DPPO Out-of-Network |
|---|---|---|
| Deductible (Deductible waived for preventive services) | $50/$150 | $50/$150 |
| Annual Out-of-Pocket Max per member | $2,000 | $2,000 |
| Preventive (cleanings) | 100% | 100% |
| Basic (fillings) | 90% | 80% |
| Major (crowns, dentures) | 60% | 50% |
| Orthodontia (child and adult) | 50% | 50% |
| Orthodontics Lifetime Maximum | $1,500 | $1,500 |
Pay less with in-network providers
The Cigna DPPO plan allows you to choose any provider you wish and receive benefits. The covered benefits listed above apply to both in-network and out-of-network dental care for each plan. However, you generally pay less when you go to a network dentist because dentists in the network have agreed to charge discounted fees.
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Semi-Monthly Rates
| Benefit plan | Employee | Employee + Spouse/DP |
Employee + Child(ren) |
Family |
|---|---|---|---|---|
| Cigna DPPO | $8.00 | $16.00 | $21.00 | $31.00 |
