Our dental plans help you maintain a healthy smile through regular preventive dental care. With the Dental PPO, you can use out-of-network providers, but you’ll save money if you use a provider in the Delta Dental or Cigna PPO network. The DHMO covers services from DHMO providers only.
The PPO dental plan offers you the freedom and flexibility to choose any licensed dentist. You receive the greatest savings when you visit a Preferred Dentist. If you visit a non-preferred provider, you will pay a percentage of the Reasonable and Customary (R&C) fee based on the dentist’s rates.
The DHMO works like a medical HMO plan in that you must receive your care from your primary DHMO provider. This plan offers a full range of dental services, and you pay a copay based on the type of service you receive. Please see the benefit schedule for a list of copays.
| Plan Features | Dental PPO Plan (Delta Dental in ID/OR/WA; Cigna Dental all other states) |
Dental DMHO Plan | ||
|---|---|---|---|---|
| Delta Dental PPO/ Cigna DPPO Advantage |
Delta Dental Premier/ Cigna DPPO |
Out-of-Network | Cigna DHMO Dentist Only | |
| Calendar Year Deductible Individual/Family | $50 / $150 | None | ||
| Calendar Year Maximum | $1,500/person | Unlimited | ||
| Orthodontia Lifetime Maximum | $1,500/person | Not covered | ||
| You pay: | You pay: | |||
| Diagnostic & Preventive | $0 | 20%1 | 20%2 | $5 |
| Basic & Restorative | 10%3 | 20%3 | 20%3 | Fixed copay |
| Major Services | 40%3 | 50%2,3 | 50%1,3 | |
| Orthodontia | 50%3 | Fixed copay | ||
| Temporomandibular Joint (TMJ) | You pay 40% | You pay 50% | You pay 50% | Fixed copay |
1Percentage applies to negotiated rate.
2Percentage applies to usual, customary, and reasonable charges.
3After deductible.
cigna.com
800-244-6224
Group #: 2499682
deltadentalins.com
800-765-6003
Group #: 19192
