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Voluntary Dental, continued
Here is an overview of our third dental plan, a Dental HMO offered through Cigna. For a list of Cigna dental HMO
providers, visit
mycigna.comor call (800) 244-6224.
CIGNA DHMO A3O09
In-Network
Plan Year Deductible
$0
$0
Plan Year Maximum
Unlimited
Waiting Period
None
Diagnostic and Preventive
$0-$240*
Basic Services
Fillings
$10-$90*
Root Canals
$6-$325*
Periodontics
$30-$300*
Major Services
Crowns, Dentures
Dental Implant
$12-$350*
$55-$650*
Orthodontic Services
Orthodontia
$50-$400**
Lifetime Maximum
Unlimited
Dependent Children up to age 19
$1,800 copay***
Adults
$2,400 copay***
*varies by services
**additional fees apply for comprehensive treatment and banding
***assumes 24 months of treatment
CIGNA DENTAL HMO SCHEDULE OF BENEFITS
For a complete list of fees for our Dental HMO plan with
Cigna, visit AlliantNet.