This section provides you with answers to the most frequently asked questions about the Dental Plan.
Who is eligible for the dental benefit?
Only active employees and bridging participants are eligible for the dental benefit. Retirees are not eligible for this benefit.
What types of procedures are covered under the dental benefit?
The Plan covers most common dental procedures that are needed to establish and maintain the health of your teeth and gums. This includes preventive procedures such as cleanings and X-rays; basic procedures such as fillings, root canals, and oral surgery; and major procedures such as crowns, bridges, and dentures. Refer to the dental coverage for a listing of dental procedures that are covered and not covered as well as maximums and limits.
What percentage of dental expenses does the Plan cover?
In general, the Plan pays 100% of expenses for preventive procedures, 80% for basic procedures, and 60% for major procedures.
For care received in the United States, these percentages only apply if you use a dentist who participates in Cigna’s Preferred Provider Organization (PPO) network of dentists. If you use a U.S. dentist who is not in Cigna’s preferred network, the Plan will pay 90% for preventive procedures, 70% for basic procedures, and 50% for major procedures.
What is the maximum the Plan will pay for dental services?
The Plan will pay up to $2,000 per calendar year for the dental expenses of each covered person.
How can I find a dentist?
You will find a list of providers through your Cigna Personal Webpage account. Please refer to the instructions for creating an account. To find a dentist in the United States, please use the Cigna PPO in-network providers.
Why should I use a dentist in the list of network providers?
You should use a provider in the network to save time and money. You can minimize your out-of-pocket dental expenses by using providers that are in Cigna’s network outside the United States and Cigna’s PPO network in the United States. Both in- and out-of-network providers within the United States submit the claims for their expenses directly to Cigna, so you can avoid paperwork by using them.
Are there limits on what the Plan will pay to the dentists?
Yes, the Plan will pay a percentage of what Cigna determines to be the reasonable charge for each dental expense. The reasonable charge for a service or supply is the lower of the dentist’s usual charge for furnishing it, and the charge Cigna determines to be the prevailing charge level made for it in the geographic area where it is furnished. If your dentist bills for more than the reasonable charge, you are financially responsible for the excess charge. If you use a dentist in the Cigna PPO network, the total charge will never exceed the reasonable charge.
Are there limits on the number of dental services performed?
Yes, each participant is limited to two oral exams and cleanings per year unless your dentist submits a valid reason for more frequent services. Bitewing X-rays are limited to one set each year, and full mouth X-rays are limited to one set each three years. Replacement of dentures, a fixed bridge, and crown is limited to once every five years.
What types of dental expenses are not covered under the Dental Plan?
The Plan does not cover the following dental expenses:
- cosmetic dentistry or treatment of temporomandibular joint syndrome (TMJ)
- dental appliances that are lost or stolen
- dental care that is determined by Cigna to be unnecessary or experimental
- charges that are covered by the Medical Plan, such as dental treatment due to an accidental injury
Please refer to the IARC Medical Plan Brochure for a more comprehensive description of covered versus non-covered dental expenses.