Cigna is the dental carrier for the State of Connecticut’s three dental plans:
Basic Plan. This plan allows you to visit any dentist or dental specialist without a referral.
Enhanced Plan. This plan also allows you to visit any dentist or dental specialist without a referral, but pays a different level of benefits than the Basic Plan.
DHMO® Plan (DHMO). This plan provides dental services only from a defined network of dentists and pays benefits only when you receive care from a network dentist (except in cases of emergency). You must select a primary care dentist. He/she will coordinate your care. Referrals are required for all specialist services.
Many of the Basic and Enhanced Plan network dentists have agreed to offer their discounted fees to you and your enrolled dependents for non-covered services. You must visit network dentists to receive the discounts (savings will not apply for care received from non-participating dentists). Discounts on non-covered services may not be available in all states. Certain dentists may not offer discounts on non-covered services. You must verify that a procedure is listed on the dentist’s fee schedule before receiving treatment. You are responsible for paying the negotiated fees directly to the dentist.
|Benefit Features||Basic Plan||Enhanced Plan||DHMO Plan|
|Annual deductible||None||Individual: $25
|Annual benefit maximum||None||$3,000 per person;
|Routine exams,cleanings, x-rays||Plan pays 100%||Plan pays 100%*||Covered‡|
|Periodontal maintenance**||20% coinsurance, plan pays 80% (if enrolled in HEP, covered at 100%)||Plan pays 100%*||Covered‡|
|Periodontal root scaling and planing**||50% coinsurance, plan pays 50%||20% coinsurance, plan pays 80%||Covered‡|
|Other periodontal services||50% coinsurance, plan pays 50%||20% coinsurance, plan pays 80%||Covered‡|
|Fillings||20% coinsurance, plan pays 80%||20% coinsurance, plan pays 80%||Covered‡|
|Oral surgery||33% coinsurance, plan pays 67%||20% coinsurance, plan pays 80%||Covered‡|
|Crowns||33% coinsurance, plan pays 67%||33% coinsurance, plan pays 67%||Covered‡|
|Dentures, fixed bridges||Not covered◊||50% coinsurance, plan pays 50%||Covered‡|
|Implants||Not covered◊||50% coinsurance, plan pays 50% (maximum of $500)||Covered‡|
|Orthodontia||Not covered◊||50% coinsurance, plan pays a maximum of $1,500 per person per lifetime §||Covered‡|
* You must use an in-network dentist to receive 100% coverage; if you use an out-of-network dentist, you will be subject to balance billing if your dentist charges more than the maximum allowable charge.
** If you are enrolled in the Health Enhancement Program, frequency limits and cost share are applicable.
‡ Contact Cigna at 800-244-6224 for patient copay amounts.
◊ While these services are not covered, you will get the discounted rate on these services if you visit an in-network dentist, unless prohibited by state law.
§ Benefits prorated over the course of treatment.
|Compare||Basic Plan||Enhanced Plan||DHMO Plan|
|Can I receive services
from any dentist?
|Yes, but you will pay less
when you choose an
|Yes, but you will pay less
when you choose an
|No, all services must
be received from a
|Do I need a referral for
specialty dental care?
|Will I pay a flat rate for
|No, you will pay a
percentage of the cost of
|No, you will pay a
percentage of the cost
of most services after
you reach your annual
|Must I live in a certain
service area to enroll?
|No||No||Yes, you must live in the
DHMO’s service area
|Is orthodontia covered?||No||Ye||Yes|
|Are dentures or bridges
Before starting extensive dental procedures for which the dentist’s charges may exceed $200, you can ask your dentist to submit a pretreatment estimate to the plan. You can also help to determine the amount you will be required to pay for a specific procedure by using the plan’s website. More details about covered expenses are available by contacting Cigna at 800-244-6224 or cigna.com/stateofct.
Oral Health Integration Program®. Enrolled retirees and dependents have access to enhanced dental coverage through the Cigna Dental Oral Health Integration Program (OHIP). With this program, eligible members with certain medical conditions may receive 100% reimbursement of their copay for select covered dental services. Qualifying medical conditions for OHIP include heart disease, stroke, diabetes, pregnancy, chronic kidney disease, organ transplants, and head and neck cancer radiation. For additional information about OHIP, visit cigna.com/stateofct.
Healthy Rewards®. Cigna’s Healthy Rewards program provides discounts of up to 60% on health-related programs and services. There’s no time limit or maximum for these instant savings when you visit a participating provider or shop online. No referrals or claim forms are needed. The following Healthy Rewards programs are available: weight management, fitness and nutrition, vision and hearing care, tobacco cessation, alternative medicine, and vitamins. Learn more about Healthy Rewards at cigna.com/rewards (password: savings) or by calling 800-258-3312.
The DHMO network continues to grow! Did you know that many retirees enrolled in the Basic and Enhanced plans are already seeing DHMO providers? Be sure to check your provider’s status at cigna.com/stateofct. Enrolling in the DHMO could help you save money.
This is a question only you can answer. Each plan offers different advantages. To choose the plan that is best for you, compare the plan-to-plan features in the “Dental Coverage at a Glance” table above and weigh your priorities.
The Affordable Care Act extended benefits for children through the end of the calendar year they turn age 26 only under medical and prescription drug coverage, not dental coverage. Dental coverage ends for dependent children at age 19. For your disabled child to remain an eligible dependent, they must be certified as disabled by your medical insurance carrier before their 19th birthday for dental benefits and before their 26th birthday for medical benefits.*
*For your disabled child to remain an eligible dependent, he/she must be certified as disabled by Anthem before he/she becomes age 19 (for dental benefits; age 26 applies only for medical benefits). As a result of the COVID-19 crisis, those turning 19 in 2020 will have their coverage extended until December 31, 2020.
Yes, the Enhanced Plan and DHMO cover orthodontia for adults, up to certain limits. The Enhanced Plan pays $1,500 per person (adult or child) per lifetime. The DHMO requires a copay. The Basic Plan does not cover orthodontia for adults or children.
Yes, up to two cleanings per year are covered 100%. However, if you are in the Enhanced Plan, you must use an in-network dentist to receive 100% coverage. If you go out of the network, you may be subject to balance billing (if your out-of-network dentist charges more than the maximum allowable charge). If you enroll in the DHMO, you must use a network dentist or your exam and cleaning won’t be covered (except in cases of emergency).