Dental coverage ends for dependent children at age 26 (unless disabled*). Cigna is the administrator for all State of Connecticut dental plans:
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; they will coordinate your care. Referrals are required for all specialist services. There’s no annual deductible or calendar-year maximum. When you need care, you pay coinsurance based on the service you receive.
This plan pays benefits for services received in- and out-of-network, without a referral. When you visit an out-of-network dentist, you are responsible for all charges above the maximum allowable charge—the amount the plan would have paid if you had visited an in-network dentist. That means your out-of-pocket expenses may be higher if you see a dentist who is not part of the Cigna PPO Network.
This plan requires you to select a primary care dentist to coordinate your care and refer you to other in-network specialists as needed. There’s no annual deductible or annual maximum. You will pay copays based on the service you receive.
This plan allows you to visit any dentist or dental specialist without a referral.
Summary of Benefits and Coverage (SBC)
Dental Patient Charge Schedules
|Total Care DHMO Plan (network only)||Enhanced Plan (network)||Cigna Dental Care DHMO (network only)||Basic Plan (any dentist)|
|Annual deductible||None||Individual: $25
|Annual maximum||None||$3,000 per person
|Exams, cleanings and x-rays||Plan pays 100%||Plan pays 100%,
deductible does not apply 1
|Plan pays 100%||Plan pays 100%|
|Periodontal maintenance 2||You pay 15%, plan pays 85%||Plan pays 100% 1||Copay 3||You pay 20%, plan pays 80% (if enrolled in HEP,
plan pays 100%)
|Periodontal root scaling and planing 2||You pay 15%, plan pays 85%||You pay 20%, plan pays 80%||Copay 3||You pay 50%, plan pays 50%|
|Other periodontal services||You pay 15%, plan pays 85%||You pay 20%, play pays 80%||Copay 3||You pay 50%, plan pays 50%|
|Fillings||You pay 15%,
plan pays 85%
|You pay 20%, plan pays 80%||Copay 3||You pay 20%, plan pays 80%|
|Oral surgery||You pay 15%,
plan pays 85%
|You pay 20%, plan pays 80%||Copay 3||You pay 33%, plan pays 67%|
|Crowns||You pay 30%,
plan pays 70%
|You pay 33%, plan pays 67%||Copay 3||You pay 33%, plan pays 67%|
|Dentures, fixed bridges||You pay 45%,
plan pays 55%
|You pay 50%, plan pays 50%||Copay 3||Not covered 4|
|Implants||You pay 45%, plan
pays 55% (one per year)
|You pay 50%, plan pays 50% (plan pays benefits
up to $500)
|Copay 3||Not covered 4|
|Orthodontia||You pay 45%,
plan pays 55%
|You pay 50%, plan pays 50%. Plan pays maximum
of $1,500 per person per
|Copay 3||Not covered 4|
* For your disabled child to remain an eligible dependent, he or she must be certified as disabled by Anthem before he or she becomes age 19 (for dental benefits; age 26 applies only for medical benefits).
1 In the Enhanced plan, be sure to use an in-network dentist to ensure your care is covered 100%; with out-of-network dentists, you will be subject to balance billing if your dentist charges more than the maximum allowable charge.
2 If you’re enrolled in the Health Enhancement Program (HEP), frequency limits and cost share are applicable.
3 Contact Cigna at 800-244-6224 for patient copay amounts.
4 While not covered, you will get the discounted rate on these services if you visit a network dentist, unless prohibited by state law (see page 15 for details).
5 Benefits are prorated over the course of treatment.
July 1, 2022 Through June 30, 2023 (26 Pay Periods)
If you do not enroll in HEP, you’ll pay an additional $46.15 per paycheck for the cost of coverage. (Employees on semimonthly pay schedules will have slightly higher premiums.)
|Biweekly Rate||Annual Total||Biweekly Rate||Annual Total||Biweekly Rate||Annual Total||Biweekly Rate||Annual Total|
|Total Care DHMO||$0.00||$0.00||$5.01||$130.26||$7.10||$184.60||$2.93||$76.18|
|Cigna Dental Care DHMO||$0.00||$0.00||$4.02||$104.52||$5.70||$148.20||$2.34||$60.84|
Employees (including dependents) enrolled in a State of Connecticut dental plan are eligible for Cigna’s Oral Health Integration Program (OHIP). OHIP provides 100% reimbursement of copays for select covered services to members with qualifying medical conditions.
If you are pregnant or have a qualifying medical condition (heart disease, stroke, diabetes, maternity, chronic kidney disease, organ transplants, and head and neck cancer radiation), you are encouraged to enroll in this program to reduce your costs.
Many of the Basic and Enhanced plan Cigna PPO network dentists have agreed to offer their discounted fees to you and your covered dependents for non-covered services. These savings may also apply to services that would not be covered because you reached your annual benefit maximum or due to other plan limitations such as frequency, age or missing tooth limitations.
You must visit a network dentist to receive these discounts. And you should verify that the procedure is listed on the dentist’s fee schedule before receiving treatment. You are responsible for paying the negotiated fee directly to the dentist.
Discounts on non-covered services may not be available in all states. Certain dentists may not offer discounts on non-covered services. Be sure to check with your dental care professional, or contact Cigna customer service before receiving care to determine if these discounts will apply to you.
Before starting extensive dental procedures where charges may exceed $200, your dentist may 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.
Yes. Your dependent can now remain on your dental coverage through the end of the year in which they turn 26. If your dependent is under 26, and was previously removed from your coverage, they will need to be added back during Open Enrollment.
* For your disabled child to remain an eligible dependent, they must be certified as disabled by your medical insurance carrier before they turn age 26 for medical and dental benefits. Contact Anthem’s Enhanced Dedicated Member Services team at 800-922-2232 for information.
Yes, the Total Care DHMO plan, Enhanced plan and Cigna Dental Care DHMO plan all cover orthodontia for adults. The Total Care DHMO plan covers 55% of the cost with an in‐network provider. The Enhanced plan pays $1,500 per person per lifetime and covers 50% of the cost for adults and children. The Cigna Dental Care DHMO requires a set copay for in‐network providers. The Basic plan does not cover orthodontia for adults or children.
Yes, up to two per year. However, if you are in the Enhanced plan, you must use an in-network dentist to get the full coverage. If you go out of network, you may be subject to balance billing (if your out-of-network dentist charges more than the maximum allowable charge). In the DHMOs, you must use an in-network dentist, or your exam won’t be covered at all.