Individual and Family Dental Plan Comparison
Cigna Dental Preventive Cigna Dental 1000 Cigna Dental 1500
Individual Calendar-Year Deductible Not applicable $50 $50
Family Deductible Not applicable $150 $150
Waived for Preventive (Class I) Not applicable Yes Yes
Dental Calendar-Year Maximum Not applicable $1,000 $1,500
Waiting Period (Class I, II, III, and IV or IX if covered)
1
Not applicable 0, 6, 12 months 0, 6, 12 months
Cigna DPPO Advantage
4
Cigna DPPO Advantage Cigna DPPO Advantage
Out-of-Network
2
Covered Covered Covered
Vision Exam Coinsurance and Calendar-Year Maximum Not covered Not covered Not covered
Vision Materials Calendar-Year Maximum Not covered Not covered Not covered
Hearing Exam Calendar-Year Maximum Not covered Not covered Not covered
Hearing Aid Calendar-Year Maximum Not covered Not covered Not covered
Average Premium
3
$19.73 $35.25 $40.89
Age 0–24 $19.73 $28.05 $32.76
Age 25–59 $19.73 $32.23 $37.47
Age 60+ $19.73 $40.18 $45.49
Class I - Diagnostic and Preventive
Oral Exams, Cleanings and Routine X-Rays
2
(Examples) Plan pays 100% Plan pays 100% Plan pays 100%
Preventive/Diagnostic Services Waiting Period Not applicable Not applicable Not applicable
Fillings and Simple Extractions
2
(Examples) Not covered Plan pays 80% Plan pays 80%
Basic Services Waiting Period Not applicable 6 months
1
6 months
1
Crowns, Dentures and Bridges
2
(Examples)
Not covered Plan pays 50% Plan pays 50%
Major Services Waiting Period Not applicable 12 months
1
12 months
1
Class IV - Orthodontia
Not covered Not covered Plan pays 50%
Orthodontia Waiting Period Not applicable Not applicable 12 months
1
Orthodontia Lifetime Deductible Not applicable Not applicable $50 per person
Orthodontia Lifetime Maximum Not applicable Not applicable $1,000 per person
Class IX - Implants
Not covered Not covered Not covered
Implant Waiting Period Not applicable Not applicable Not applicable
Implant Lifetime Deductible Not applicable Not applicable Not applicable
Implant Lifetime Maximum Not applicable Not applicable Not applicable
For MD & NY, see state-specic versions.
Not for use in NM.
This summary contains highlights only. For additional plan information, including out-of-network benets, view the Summary of Benets.
FOR AGENT/BROKER USE ONLY. DO NOT DISTRIBUTE.
1. Waiting periods may vary by state; refer to the policy for more details. Waiting periods for Class 2 and 3 may be waived at the individual customer level if the application indicates that there were 12 months or more of prior dental coverage that included coverage for
Class 3, Major Restorative services, and not more than 63 days have lapsed between the prior coverage and this plan. Any prior dental insurance plan that did not include Class 3 services will not count toward waiting period waiver. Orthodontia and implant waiting
periods are not eligible for waiver.
2. Covered services have frequency limitations, and some covered services are determined by age. For a complete listing of covered services, please read your plan documents. You are free to choose a provider from our large national network or one from outside the
network. Keep in mind, you’ll save the most if you visit a network provider. If you choose to visit a dentist out-of-network, you will pay the out-of-network benet and the dierence in the amount that Cigna Healthcare reimburses for such services and the amount
charged by the dentist, except for emergency services as dened in your policy. This is known as balance billing.
3. Premiums vary by geographic area. Sample rates shown reect single coverage. Cigna internal data as of November 2023.
4. In Texas, the insured dental plan is known as Cigna Dental Choice, and this plan uses the national Cigna DPPO network.
969365a 12/23
Cigna Dental 3000/100
Individual Calendar-Year Deductible $100
Family Deductible Not applicable
Waived for Preventive (Class I) No
Dental Calendar-Year Maximum $3,000
Waiting Period (Class I, II, III, and IV or IX if covered)
1
0, 6, 12 months
Total Cigna DPPO
Out-of-Network
2
Covered
Vision Exam Coinsurance and Calendar-Year Maximum Not covered
Vision Materials Calendar-Year Maximum Not covered
Hearing Exam Calendar-Year Maximum Not covered
Hearing Aid Calendar-Year Maximum Not covered
Average Premium
3
$32.40
Age 0–24 $23.47
Age 25–59 $26.08
Age 60+ $38.22
Class I - Diagnostic and Preventive
Oral Exams, Cleanings and X-Rays
2
(Examples) Plan pays 100%
Preventive/Diagnostic Services Waiting Period Not applicable
Fillings and Simple Extractions
2
(Examples) Plan pays 50%
Basic Services Waiting Period 6 months
1
Crowns, Dentures and Bridges
2
(Examples)
Plan pays 50%
Major Services Waiting Period 12 months
1
Class IV - Orthodontia
Not covered
Orthodontia Waiting Period Not applicable
Orthodontia Lifetime Deductible Not applicable
Orthodontia Lifetime Maximum Not applicable
Class IX - Implants
Not covered
Implant Waiting Period Not applicable
Implant Lifetime Deductible Not applicable
Implant Lifetime Maximum Not applicable
1. Waiting periods may vary by state; refer to the policy for more details. Waiting periods for Class 2 and 3 may be waived at the individual customer level if the application indicates that there were 12 months or more of prior dental coverage that included coverage for Class 3, Major Restorative services,
and not more than 63 days have lapsed between the prior coverage and this plan. Any prior dental insurance plan that did not include Class 3 services will not count toward waiting period waiver. Orthodontia and implant waiting periods are not eligible for waiver.
2. Covered services have frequency limitations, and some covered services are determined by age. For a complete listing of covered services, please read your plan documents. You are free to choose a provider from our large national network or one from outside the network. Keep in mind, you’ll save the
most if you visit a network provider. If you choose to visit a dentist out-of-network, you will pay the out-of-network benet and the dierence in the amount that Cigna Healthcare reimburses for such services and the amount charged by the dentist, except for emergency services as dened in your policy.
This is known as balance billing.
3. Premiums vary by geographic area. Sample rates shown reect single coverage. Cigna internal data as of November 2023.
4. In Texas, the insured dental plan is known as Cigna Dental Choice, and this plan uses the national Cigna DPPO network.
This summary contains highlights only. For additional plan information, including out-of-network benets, view the Summary of Benets.
Individual and Family Dental Plan Comparison
FOR AGENT/BROKER USE ONLY. DO NOT DISTRIBUTE.
Cigna Dental Vision 1000 Cigna Dental Vision Hearing 2000 Cigna Dental Vision Hearing 3500
Individual Calendar-Year Deductible $50 $100 $100
Family Deductible $150 Not applicable Not applicable
Waived for Preventive (Class I) Yes Yes Yes
Dental Calendar-Year Maximum $1,000 $1,500 $2,500
Waiting Period (Class I, II, III, and IV or IX if covered)
1
0, 0 months 0, 0, 12 months 0, 0, 6, 12 months
Cigna DPPO Advantage Cigna DPPO Advantage Cigna DPPO Advantage
Out-of-Network
2
Covered Covered Covered
Vision Exam Coinsurance and Calendar-Year Maximum 30% up to $50 50% up to $75 90% up to $100
Vision Materials Calendar-Year Maximum $100 $200 $300
Hearing Exam Calendar-Year Maximum Not covered $50 $50
Hearing Aid Calendar-Year Maximum Not covered $500 $700
Average Premium
3
$31.75 $50.26 $61.94
Age 0–24 $31.52 $41.25 $51.63
Age 25–59 $31.99 $45.38 $57.92
Age 60+ $32.61 $51.46 $67.09
Class I - Diagnostic and Preventive
Oral Exams, Cleanings and X-Rays
2
(Examples) Plan pays 100% Plan pays 100% Plan pays 100%
Preventive/Diagnostic Services Waiting Period Not applicable Not applicable Not applicable
Fillings and Simple Extractions
2
(Examples) Plan pays 70% Plan pays 70% Plan pays 80%
Basic Services Waiting Period Not applicable Not applicable Not applicable
Crowns, Dentures and Bridges
2
(Examples)
Not covered Plan pays 50% Plan pays 50%
Major Services Waiting Period Not applicable 12 months
1
6 months
1
Class IV - Orthodontia
Not covered Not covered Not covered
Orthodontia Waiting Period Not applicable Not applicable Not applicable
Orthodontia Lifetime Deductible Not applicable Not applicable Not applicable
Orthodontia Lifetime Maximum Not applicable Not applicable Not applicable
Class IX - Implants
Not covered Not covered Plan pays 50%
Implant Waiting Period Not applicable Not applicable 12 months
1
Implant Lifetime Deductible Not applicable Not applicable Not applicable
Implant Lifetime Maximum Not applicable Not applicable $2,000
This summary contains highlights only. For additional plan information, including out-of-network benets, view the Summary of Benets.
Individual and Family Dental Plan Comparison
FOR AGENT/BROKER USE ONLY. DO NOT DISTRIBUTE.
1. Waiting periods may vary by state; refer to the policy for more details. Waiting periods for Class 2 and 3 may be waived at the individual customer level if the application indicates that there were 12 months or more of prior dental coverage that included coverage for Class 3, Major Restorative services,
and not more than 63 days have lapsed between the prior coverage and this plan. Any prior dental insurance plan that did not include Class 3 services will not count toward waiting period waiver. Orthodontia and implant waiting periods are not eligible for waiver.
2. Covered services have frequency limitations, and some covered services are determined by age. For a complete listing of covered services, please read your plan documents. You are free to choose a provider from our large national network or one from outside the network. Keep in mind, you’ll save the
most if you visit a network provider. If you choose to visit a dentist out-of-network, you will pay the out-of-network benet and the dierence in the amount that Cigna Healthcare reimburses for such services and the amount charged by the dentist, except for emergency services as dened in your policy.
This is known as balance billing.
3. Premiums vary by geographic area. Sample rates shown reect single coverage. Cigna internal data as of November 2023.
4. In Texas, the insured dental plan is known as Cigna Dental Choice, and this plan uses the national Cigna DPPO network.
Please see the Policy, Outline of Coverage or Summary of Benets for exclusions and limitations. Dental preferred-provider insurance policies have exclusions, limitations, reduction of benets and terms under which a policy may be
continued in force or discontinued:
Cigna Dental Preventive, 1000 and 1500 plans: AL, CO, CT, DE, HI, IA, IL, MI, ND, WV and WY: HC-NOT11 et al., AK: HC-NOT53, AR: HC-NOT36 et al., AZ: INDDENTPOLAZ032017, CA: INDDENTPOLCA0713 et al., DC: HC-NOT42 et al., FL: HC-NOT15 et al., GA:
INDDENPOLGA0317, ID: HC-NOT51 et al., IN: HC-NOT23 et al., KS: HC-NOT49 et al., KY: HC-NOT44 et al., LA: INDDENTPOLLA0713, MA: HC-NOT11, HC-NOT32, et al., ME: HC-NOT58 et al., MD:INDDENTPOLMD.PREV, INDDENTPOLMD.1000, INDDENTPOLMD.1500 and
MDINDSADOHIPAMND10-20, MI: INDSADPOLMI.1000, INDENTPOLAMI042021.1500, INDENTPOLAMI042021.Prev, MO: INDDENTPOLMO0713, MN: INDDENTPOLMN0713, MS: HC-NOT48 et al., MT: INDDENTPOLMT0713, NC: HC-NOT18, NE HC-NOT47 et al., NH,
INDDENTPOLNH.1000, INDDENTPOLNH.1500, INDDENTPOLNH.PREV, NJ: HC-NOT46, et al., NM: INDDENPOLNM0322.1000 and INDDENPOLNM0322.1500, NY: INDDENTPOLNY.PREV, INDDENTPOLNY.1000, INDDENTPOLNY.1500, NV: HC-NOT39 et al., OH: INDDENTPOLOH0317,
OK: HC-NOT26 et al., OR: INDDENTPOLOR0713, PA:INDDENPOLPA0917, RI: INDDENPOLRI0918., SC: HC-NOT19 et al., SD: HC-NOT59 et al., TN: HC-NOT20 et al., TX: HC-NOT21 et al., UT: HC-NOT50 et al., VA: INDDENTPOLVA0317, VT HC-NOT56 et al., WA: INDDENTPOLWA0317, WI
HC- NOT54 et al).
Cigna Dental Preventive plan is not available in NM.
Cigna Dental 3000/100 plan: AL, CO, CT, DE, HI, IA, IL, ND, PA, WV and WY: HC-NOT11 et al., AK: HC-NOT53 et al., AR: HC-NOT36 et al., AZ: INDDENPOLAZ, DC: HC-NOT42 et al., FL: HC-NOT15 et al., GA: INDDENPOLGAv1, ID: HC-NOT51 et al., IN: HC-NOT23 et al., KS:
HC-NOT49 et al., KY: HC-NOT44 et al., LA: INDDENPOLLA, ME: INDDENPOLME, MI: INDDENPOLMI, MO: INDDENPOLMO, MS: HC-NOT48 et al., MT: INDDENPOLMT, NC: HC-NOT18 et al., NE HC-NOT47 et al., NH: INDDENPOLNH, NM: INDDENPOLNM, NJ: HC-NOT46 et al., NV: HC-
NOT39 et al., OH: INDDENPOLOH, OK: HC-NOT26 et al., RI: INDDENPOLRI, SC: INDDENPOLSC1022, SD: HC-NOT59 et al., TN: HC-NOT20 et al., TX: HC-NOT21 et al., UT: HC-NOT50 et al., VT: HC-NOT56 et al., WI: HC-NOT54 et al, VA: INDDENPOLVA.
Cigna Dental 3000/100 plan is not available in CA, MA, MD, MN, NY, OR and WA.
Cigna Dental Vision/Dental Vision Hearing: INDDVPOL[State]1021.1000, INDDVHPOL[State], 1021.2000, INDDVHPOL[State], 1021.3500 (AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NV, OH,
OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WI, WV and WY).
Cigna Dental Vision/Dental Vision Hearing plans are not available in MT, NM, NY, VA and WA.
Product availability may vary by location and plan type and is subject to change. All dental insurance policies and dental benet plans contain exclusions and limitations. For costs and details of coverage, review your plan documents
or contact a Cigna Healthcare representative.
All Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group. The Cigna Healthcare name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
Not for use in New Mexico.
969365a 12/23 © 2023 Cigna Healthcare.
