Contacts & Resources


The Dental PPO plan allows you to see any provider you choose. To minimize your out-of-pocket costs, use Cigna network providers.

Dental Plan at a Glance

Plan Provision

In-Network and Out-of-Network*

Waived for preventive and orthodontia services

$50 individual
$150 family

Preventive Services
Cleanings, exams

Plan pays 100%

Basic Services
Fillings, endodontics, periodontics

Plan pays 80%

Major Services
Crowns, bridges, implants

Plan pays 50%

Orthodontia Services
Adults and children

Plan pays 50%

Dental Annual Maximum


Orthodontia Lifetime Maximum
Adults and children


* Out-of-network benefits are limited to the Usual, Customary & Reasonable (UCR) charge amount. If your out-of-network provider charges more than the UCR amount, you may be responsible for paying the excess amount in addition to the percentage you would normally pay in-network.