Dental Benefits

Name: Axiom
Address: United States

Network: Total Cigna DPPO (Cigna DPPO Advantage and Cigna DPPO)

	Cigna PPO Advantage In-Network	Cigna DPPO In-Network	Out-of-Network (Balance Billing May Apply)
Diagnostic	100%, No Deductible	100%, No Deductible	100%, No Deductible
Preventive	100%, No Deductible	100%, No Deductible	100%, No Deductible
Basic	90%, After Deductible	80%, After Deductible	80%, After Deductible
Major	60%, After Deductible	50%, After Deductible	50%, After Deductible
Orthodontics (Child Only Under Age 19)	50%, No Deductible	50%, No Deductible	50%, No Deductible
Orthodontia Lifetime Maximum	$1,000	$1,000	$1,000
Calendar Year Maximum	$1,500	$1,500	$1,500
Deductible (Individual/Family)	$50/$150	$50/$150	$50/$150
Dependent Age	26	26	26

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Cigna

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