Dental Plan Coverage
- Basic Plan. This plan allows you to visit any dentist or dental specialist without a referral.
- Enhanced Plan. This plan will pay benefits for services received in- and out-of-network, without a referral. However, your out-of-pocket expenses may be higher if you see a dentist who is not part of the Cigna PPO Network. The Enhanced Plan pays for covered dental services based on the maximum allowable charge, which is the amount your plan would pay had you visited an in-network dentist. When you visit an out-of-network dentist, you are responsible for all charges above the maximum allowable charge, up to that dentist’s usual charge for those services.
- DHMO Plan. This plan provides dental services only from a defined network of dentists. You must select a Primary Care Dentist (PCD) to coordinate all care, and referrals are required for all specialist services.
Compare Plans
| Basic Plan (any dentist) | Enhanced Plan (network) | DHMO® Plan (network only) | |
|---|---|---|---|
| Annual Deductible | None |
Individual: $25 Family: $75 |
None |
| Annual Maximum | None | $3,000 per person (excluding orthodontia) | None |
| Exams, Cleanings and X-Rays | Plan pays 100% | Plan pays 100%, deductible does not apply1 | Plan pays 100% |
| Periodontal Maintenance2 | 20% (if enrolled in HEP, Plan pays 100%) | Plan pays 100%1 | Copay3 |
| Periodontal Root Scaling and Planing2 | 50% | 20% | Copay3 |
| Other Periodontal Services | 50% | 20% | Copay3 |
| Simple Restoration | |||
| Filings | 20% | 20% | Copay3 |
| Oral Surgery | 33% | 20% | Copay3 |
| Major Restorations | |||
| Crowns | 33% | 33% | Copay3 |
| Dentures, Fixed Bridges | Not covered4 | 50% | Copay3 |
| Implants | Not covered4 | 50% (Plan pays benefits up to $500) | Copay3 |
| Orthodontia | Not covered4 | Maximum of $1,500 per person per lifetime5 | Copay3 |
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 1-800-244-6224 for patient co-pay 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.
5 Benefits prorated over the course of treatment.
Biweekly Rates
Dental Plans
Employee
Employee +1
Family
FLES**
Dental Plans
Basic
Employee
$0.00
Employee +1
$11.11
Family
$11.11
FLES**
$5.70
Dental Plans
Enhanced
Employee
$0.00
Employee +1
$9.58
Family
$9.58
FLES**
$4.91
Dental Plans
DHMO
Employee
$0.00
Employee +1
$3.86
Family
$5.47
FLES**
$2.25
** The Family Less Employed Spouse (FLES) rate is available only when both spouses are enrolled in active coverage, eligible for health insurance, and enrolled in the same plan, along with at least one child. If you are enrolled in the FLES coverage level, both you and your spouse must enroll in order to participate in the Health Enhancement Program.
Oral Health Integration Program
Employees (including dependents) enrolled in a State of Connecticut dental plan are eligible for Cigna’s Oral Health Integration Program (OHIP). OHIP provides members with qualifying medical conditions 100% reimbursement of their copay for select covered services.
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.
Savings on Non-Covered Services
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 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.
Pre-Treatment Estimates
Before starting extensive dental procedures where charges may exceed $200, your dentist may submit a pre-treatment estimate to the plan. You can also help to determine the amount you will be required to pay for a specific procedure using the chart above.
Coverage for Fillings under the Basic and Enhanced Plan
There’s not always one simple answer for treating a dental condition. You and your dentist should discuss the various options, and then you can decide on the best approach. Your costs may vary based on the treatment plan you choose.
Dental coverage ends for dependent children at age 19 (unless disabled*).
*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.
Improvements This Year!
Enhanced Plan
- Fluoride age limit increased to 19 years old
- No age limit on sealants
- Brush biopsy covered at 100% by the Plan
- Exparel (non-opioid pain management) covered at 50% by the Plan
Basic Plan
The Basic Plan will have all of the above improvements, plus:
- Occlusal guards covered at 50% by the Plan
- No periodontal maximum (previously $500)
Frequently Asked Questions
Can my children be covered under my dental plan until age 26, like they can under my medical plan?
The Affordable Care Act extended benefits for children until age 26 only under medical and prescription drug coverage, not dental. Dental coverage ends for dependent children at age 19 (unless they are disabled*).
* For your disabled child to remain an eligible dependent, they must be certified as disabled by your medical insurance carrier before they turn age 19 for dental benefits or age 26 for medical benefits. Contact Anthem’s Enhanced Dedicated Member Services team at 800-922-2232 for information.
Do any of the dental plans cover orthodontia for adults?
Yes, the Enhanced Plan and DHMO both 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.
If I participate in HEP, are my regular dental cleanings 100% covered?
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 DHMO you must use an in-network dentist or your exam won’t be covered at all.