Dental Benefits
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Network: Total Cigna DPPO (Cigna DPPO Advantage and Cigna DPPO)
In-Network Cigna PPO Advantage |
In-Network Cigna DPPO |
Out-of-Network (Balance Billing May Apply) |
|
|---|---|---|---|
Deductible |
$50/$150 |
$50/$150 |
$50/$150 |
Calendar Year Maximum |
$1,500 |
$1,500 |
$1,500 |
Dependent Age |
26 |
26 |
26 |
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 |
Bi-Weekly Employee Rates |
|
|---|---|
Employee |
$0.00 |
Employee + Spouse |
$14.63 |
Employee + Child(ren) |
$14.76 |
Family |
$35.32 |