Regular checkups and good dental hygiene are an important part of your overall health. Veradigm offers two dental plan options:
- The Cigna Dental Preferred Provider Organization (PPO) plan is available nationwide.
- The Cigna Dental Health Maintenance Organization (DHMO) plan is available in certain locations.
Dental plan at a glance
|Deductible (individual/family)||$0/$0||$50/$150||No deductible|
|Annual benefit maximum (per person)||$2,000||$2,000||No maximum|
|Orthodontia lifetime maximum (per person)||$1,500||$1,500||No maximum|
|Preventive and Diagnostic
||100% of the DPPO fee||100% of the reasonable and customary (R&C) fee||100%|
||80% of the DPPO fee||80% of the R&C fee, after deductible||The DHMO sets the cost for services based on a Patient Charge Schedule (PCS)|
||60% of the DPPO fee||60% of the R&C fee, after deductible||See the PCS|
|Orthodontia Services||60% of the DPPO fee||60% of the R&C Fee, after deductible|
How does the Cigna DPPO plan work?
With the Cigna DPPO plan:
- You can go to any dentist but typically spend less when you visit a Cigna in-network dentist.
- You do not have to choose a network dentist ahead of time, you choose a dentist when you are ready to make an appointment.
- No ID Cards needed. Your Group Number (3339080) is all your dentist will need to confirm your dental coverage and submit a claim.
DPPO in-network services are based on the fee amount the DPPO provider has agreed to charge for covered services. An in-network provder will not bill you for charges in excess of the in-network negotiated fees.
DPPO out-of-network services are based on the reasonable and customary (R&C) amount that Cigna determines using the lowest of either the dentist’s actual charge, the dentist’s usual charge, or the charge of most dentists in the same geographic area for the same/similar service. Out-of-network dentists may bill you for amounts that exceed the R&C fee limit.
How does the Cigna DHMO plan work?
With the DHMO plan:
- There are no deductibles to meet.
- Your share of out-of-pocket costs is listed on your Patient Charge Schedule (PCS).
- Referrals are required for some specialty care services. Exceptions are pediatric dentists for children under 7, orthodontics and endodontics.
- There are no dollar maximums, no matter the amount of your covered expenses.
- There are no claim forms to file and no waiting periods for coverage.
- You will receive a dental card
When you enroll in the Cigna DHMO plan, you’ll be assigned a dentist from the Cigna Dental Care Access Plus network who will be your source for basic care, advice and referrals to other in-network specialists, if you need them. If you want to select a different dentist from the network, you can call Cigna to make a switch.
Under the DHMO, Cigna allows your network dentist to charge a certain amount. Then you pay a fixed portion of that cost, as listed in the Patient Charge Schedule (PCS). The DHMO pays the rest.
Out-of-network benefits are not offered with the Cigna DHMO plan (except for emergencies or where required by law).