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Dental
What Is Covered

The plans pay for many of the preventive, basic and major services you and your family receive. The following services are covered under each plan.

Type A - Preventive   How Many/How Often:
Prophylaxis (cleanings) Two per calendar year.
Oral Examinations Two exams per calendar year.
Topical Fluoride Applications One fluoride treatment per calendar year for dependent children up to 18th birthday.
X-rays Full mouth X-rays: one every 36 months.
Bitewing X-rays: two sets per calendar year.
Sealants

One application of sealant material every 5 years for each non-restored, non-decayed 1st and 2nd molar of a dependent child up to 19th birthday.

 

Type B - Basic Restorative   How Many/How Often:
Fillings When dentally necessary in connection with oral surgery, extractions or other covered dental services.

 

Simple Extractions
Crown, Denture, and Bridge Repair
Oral Surgery
Endodontics
General Anesthesia
Periodontics
Space Maintainers

 

Type C - Major Restorative   How Many/How Often:
Dental Implants Initial placement to replace one or more natural teeth, which are lost while covered by the Plan.
Bridges and Dentures

Initial placement to replace one or more natural teeth, which are lost while covered by the Plan.

Dentures and bridgework replacement: one every 5 years.

Replacement of an existing temporary full denture if the temporary denture cannot be repaired and the permanent denture is installed within 12 months after the temporary denture was installed.

Crowns/Inlays/Onlays Replacement: once every 5 years.

 

Type D - Orthodontia   How Many/How Often:
  • Dependents are eligible to age 21 (end of calendar year in which they turn age 21). If a full time student, dependents are eligible to age 24 (end of month in which they turn age 24).
  • All dental procedures performed in connection with orthodontic treatment are payable as Orthodontia.
  • Payments are on a repetitive basis.
  • Benefit for initial placement of the appliance will be made representing 20% of the total benefit.
  • Orthodontic benefits end at cancellation of coverage.

*The service categories and plan limitations shown above represent an overview of your Plan of Benefits. This document presents the majority of services within each category, but is not a complete description of the Plan. A summary plan description will be made available following your plan’s effective date, and will govern if any discrepancies exist between this overview and the actual summary plan description.

 


   
Dental
Plan A: High Option
Plan B: Moderate Option
What Is Covered
What Is Not Covered
2023-2024 Dental Rates
Orthodontia
When Coverage Ends
Glossary
   
Related Forms
Cigna Dental Benefit Summary Option A
Cigna Dental Benefit Summary Option B
Cigna
myCigna.com
   
Related Links
Cigna
   

Disclaimer: Brandywine Benefits Online provides only an overview of your benefits from Brandywine School District and The State of Delaware. Brandywine School District and The State of Delaware reserve the right to amend or to terminate any benefit plan at any time, with or without notice. Review more important legal information about your benefits plans.

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