DENTAL INSURANCE
CIGNA
Non-network benefits are available with PPO Base and PPO Buyup plans. Refer to the plan document for exact coverage amounts.
| DENTAL PLAN | ASSOCIATE | ASSOCIATE & SPOUSE | ASSOCIATE & CHILDREN | ASSOCIATE & FAMILY | |
| PPO Buy Up | Preventative 100% | Annual Deductible: $50 Progressive Annual Benefit Max* (non-ortho) | Annual Deductible: $150 Progressive Annual Benefit Max* (non-ortho) | Annual Deductible: $150 Progressive Annual Benefit Max* (non-ortho) | Annual Deductible: $150 Progressive Annual Benefit Max* (non-ortho) |
| Basic 80% | |||||
| Major 50% | |||||
| Orthodontics 50% (adult & child) | |||||
| $2,000 MaxLifetime | |||||
| PPO Base | Preventative 100% | Annual Deductible: $0 Progressive Annual Benefit Max** (non-ortho) | Annual Deductible: $0 Progressive Annual Benefit Max** (non-ortho) | Annual Deductible: $0 Progressive Annual Benefit Max** (non-ortho) | Annual Deductible: $0 Progressive Annual Benefit Max** (non-ortho) |
| Basic 70% | |||||
| Major 40% | |||||
| Orthodontics 50% (child only) < 19 | |||||
| $1,000 Max Lifetime |
Non-network benefits are available with PPO Buy Up and PPO Base plans. Refer to the plan document for exact coverage amounts.
When you or your family members receive any preventive care service in one plan year, the annual dollar maximum will increase in the
following plan year.
*PPO Buy Up Plan Progressive Maximum Benefit: Year 1: $1,500 Year 2: $1,650 Year 3: $1,800 Year 4: $1,950
**PPO Base Plan Progressive Maximum Benefit: Year 1: $1,000 Year 2: $1,150 Year 3: $1,300 Year 4: $1,450
| BI-WEEKLY RATES | ASSOCIATE | ASSOCIATE & SPOUSE | ASSOCIATE & CHILDREN | ASSOCIATE & FAMILY | ||||
| PPO Buy Up | $14.88 | $28.25 | $35.10 | $48.61 | ||||
| PPO Base | $9.76 | $18.57 | $23.06 | $31.96 |
