myCigna Dental Plans
(No Waiting Periods for Missouri Residents)
Summary of Benefits
Your 2015 Plan Information
| myCigna Dental | myCigna Dental 1000 |
myCigna Dental 1500 |
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|---|---|---|---|---|---|---|
| DENTAL BENEFIT | IN-NETWORK | OUT-OF NETWORK | IN-NETWORK | OUT-OF NETWORK | IN-NETWORK | OUT-OF NETWORK |
| Individual Annual Deductible | Not Applicable | $50 per person | $50 per person | |||
| Family Annual Deductible | Not Applicable | $150 per family | $150 per family | |||
| Annual Benefit Maximum | Not Applicable | $1,000 per person | $1,500 per person | |||
| Separate Lifetime Individual Orthodontia Deductible |
Not Applicable | Not Applicable | $50 per person | |||
CLASS I: PREVENTIVE/DIAGNOSTIC SERVICES
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| Preventive/Diagnostic Services Waiting Period |
Not Applicable | Not Applicable | Not Applicable | |||
| Preventive/Diagnostic Services Oral Exams, Routine Cleanings, Routine X-Rays, Sealants, Fluoride Treatment, Space Maintainers (non‑orthodontic) |
You pay 0% | You pay 0% | You pay 0% | You pay 0% | You pay 0% | You pay 0% |
CLASS II: BASIC RESTORATIVE SERVICES
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| Basic Restorative Services Waiting Period | Not Applicable | 6 month waiting period* | 6 month waiting period* | |||
| Basic Restorative Services Non‑routine X-Rays, Fillings, Routine Tooth Extraction, Emergency Treatment |
You pay 100% (discounts may apply)** |
You pay 100% |
You pay 20% (after deductible) |
You pay 20% (after deductible) |
You pay 20% (after deductible) |
You pay 20% (after deductible) |
CLASS III: MAJOR RESTORATIVE SERVICES
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| Major Restorative Services Waiting Period | Not Applicable | 12 month waiting period* | 12 month waiting period* | |||
| Major Restorative ServicesPeriodontal (Deep Cleaning), Periodontal Maintenance, Crowns, Root Canal Therapy, Wisdom Tooth Extraction, Dentures/Partials, Bridges |
You pay 100% (discounts may apply)** |
You pay 100% | You pay 50% (after deductible) |
You pay 50% (after deductible) |
You pay 50% (after deductible) |
You pay 50% (after deductible) |
CLASS IV: ORTHODONTIA
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| Orthodontia Waiting Period | Not Applicable | Not Applicable | 12 month waiting period* | |||
| Orthodontia | You pay 100% (discounts may apply)** |
You pay 100% | You pay 100% (discounts may apply)** |
You pay 100% | You pay 50% (after separate lifetime orthodontia deductible) |
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| Orthodontia Individual Lifetime Maximum | Not Applicable | Not Applicable | $1,000 per person | |||
| Rates/Apply | Rates/Apply | Rates/Apply | ||||
If you choose to visit a dentist out-of-network you will pay the out-of-network benefit and the difference in the amount that Cigna reimburses for such services and the amount charged by the dentist, except for emergency services. This is known as balance billing. * NJ, VT & IL: 6 month waiting period for all Classes; WV: 3 month waiting period for all Classes; MO & RI: no waiting period for all Classes; You may be eligible to waive the waiting period for Classes II & III if you have continuous 12 months of prior coverage from a valid dental insurance plan. ** In-network Dentists contracted with Cigna may pass along discounted rates. Discounts are not available in Virginia.
Why We Like myCigna Dental
- No Waiting Periods (when migrating from another plan)
- No Waiting Periods in Missouri!
- Wide Network of Providers Participating
- Large Annual Maximum Benefit Available.
- Great Overall Value!
- Easy To Use!
