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Dental
Plan A: High Option

Plan A offers the highest level of dental coverage. This plan stresses preventive care to help you and your family avoid serious dental problems. The plan pays 100% of the covered cost (reasonable and customary charges) of preventive and basic services. It also pays 80% of the covered cost (reasonable and customary charges) of major services and orthodontia care. The maximum benefit you can receive under this plan each year is $2,000 per person. Orthodontia care carries a separate $2,000 per person lifetime maximum.

Plan A also includes a Preferred Provider Organization (PPO) feature, which gives you the option of receiving care from PPO participating dental care providers and paying less out-of-pocket.

Participating dentists agree to charge negotiated rates. These rates are typically lower than the rates charged by non-participating dentists. This means that when you visit a participating dentist, your out-of-pocket costs may be less. Remember, when you visit a non-participating dentist, you are responsible for a percentage of the reasonable and customary charges. In addition, you pay any amount above the reasonable and customary limit. Here's an example of how you might save money using a participating dentist compared to a non-participating dentist.

Here's an Example
Let's assume you need a major procedure that's covered at 80%:

  Participating Dentist Non-participating Dentist
Provider's Regular Fee $600 $600
Negotiated Fee $375 N/A
Reasonable & Customary Limit N/A $500
Plan Pays 80% of $375 = $300 80% of $500= $400
You Pay 20% of $375 = $75

$200
($600-$400 = $200)

Savings obtained by using a participating provider: $125

NOTE: This chart is for illustrative purposes only.

To locate a participating provider in your area, visit www.cigna.com or call (800) 345-4511 to request a provider directory.

Plan Option A Benefit Summary:

Coverage Type: In-Network Out-of-Network
Type A - Preventive 100% of PDP Fee* 100% of R&C Fee**
Type B - Basic Restorative 100% of PDP Fee* 100% of R&C Fee**
Type C - Major Restorative 80% of PDP Fee* 80% of R&C Fee**
Type D - Orthodontia 80% of PDP Fee* 80% of R&C Fee**
 
Deductible*** In-Network Out-of-Network
Individual None None
Family None None
 
Annual Maximum Benefit: In-Network Out-of-Network
Per Person $2,000 $2,000
 
Orthodontia Lifetime
Maximum:
In-Network Out-of-Network
Per Person $2,000 $2,000
   
* PDP Fee refers to the fees that participating PDP dentists have agreed to accept as payment in full.
** Reasonable & Customary charges are based on the research of a dentist's usual, actual & community average charge as determined by Cigna.
*** Applies only to Type B & C Services.

 

 

 


   
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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