Dental Plan

Dentist speaking with a mature patient during a dental exam.

Administrator: CIGNA Health and Life Insurance Company(CHLIC) 
Website:  www.cigna.com
Phone: 1-800-244-6224

The Traditional Dental Plan (Dental PPO) provides payment for the following covered services, subject to the plan maximums and limitations:

Class Schedule

Class I Diagnostic and Preventive (no more than two in any calendar year). 100%  of reasonable and customary charges
Class II Basic Restorative, Endodontics, Periodontics, Maintenance of Prosthodontics and Oral Surgery 80%  of reasonable and customary charges
Class III Major Restorative, Installation of Prosthodontics 60%  of reasonable and customary charges
Class IV Orthodontics 60%  of reasonable and customary charges

    The maximum benefit, excluding Class IV Services, is $2,000 per person each year. The lifetime maximum for Class IV Services (orthodontics) is $1,000 per person. Each year, you will need to meet a deductible of $50 per person, or $150 for family. The deductible does not apply to Class I and Class IV Services. As an additional plan feature, if you use a dentist who is a member of the Preferred Provider Organization (PPO), charges for covered services will usually be discounted. This means your cost will usually be less than that associated with a dentist who is not a member of the PPO. Please remember that under the Traditional Dental Plan (Dental PPO), you may use any dentist you wish; use of the PPO feature is voluntary. Out-of-network claims submitted to CIGNA after 365 days from the date of service will be denied. 

    Effective January 1, 2019, CIGNA PPO is MCG's new dental plan carrier.  Use the Total CIGNA DPPO network of participating providers to receive in-network benefits.

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