Dental
Whitfield County Schools offers two dental plan options with Cigna: Standard and Premium. Cigna provides comprehensive coverage at a competitive cost with an extensive dental network in the Dalton area.
The Standard plan has lower rates and a lower annual maximum with no orthodontia coverage. The Premium plan has a higher premium and annual maximum and includes orthodontia coverage. Both plans have the same coinsurance and deductibles, and dependent children can be covered up to age 26, regardless of student status.
As long as you access a Total Cigna DPPO network provider, your claim will be processed at the in-network level with no balance billing. Services not covered or that exceed the calendar year maximum are the patient’s responsibility.
The DPPO network is the largest and has the best discounts. We encourage you to use a Cigna DPPO provider in order to maximize your dental plan benefits. Access www.cigna.com to locate participating dental provider information. Refer to the Cigna benefits summary for complete details regarding frequencies and coverage information.
Below is a benefit summary of your annual deductible and co-insurance costs.
Going In-Network Saves You Money
We recommend you review participating Cigna dental network information online prior to obtaining services. To locate in-network Cigna dental providers, access www.cigna.com and follow the below instructions:
- Select “Find a Doctor,” then “Employer or School”
- Click “Doctor by Name “ to search for specific dentists and complete the requested information
- To locate a list of participating dentists in the area, click “Doctor by Type” and then “Continue as Guest”
- Select Total Cigna DPPO and follow search instructions
What Is Balance Billing?
Balance billing happens when a dentist who isn’t in your plan’s network charges more than your plan pays. This is a risk when you receive services from an out-of-network dentist. Although we recommend you use network dentists, if you go out-of-network, the balance bill amount is your responsibility.
My Cigna Platform
We encourage you to register for your account on the portal or mobile app at www.mycigna.com.
Below are some features of the portal:
- Provider locator and ID Card requests
- Dental plan and coverage information and access to Explanations of Benefits (EOB)s
- Dental plan maximum accumulator information and treatment cost estimator tool
- Healthy Rewards Discount Program
- Access to the Cigna Dental Oral Health Integration Program
- Reimbursement of out-of-pocket costs for preventive dental treatment for members with certain medical conditions including, but not limited to, heart disease, stroke, diabetes, and maternity
Important Notes
- No age limitations for coverage
- Differing deductibles and annual maximums depending on plan selected
- 100% Preventive Coverage / 80% Basic Coverage / 50% Major Services / 50% Orthodontia
- Orthodontia coverage is included on the Premium Plan only
- Members utilizing Cigna participating dentists will enjoy discounted dental fees in addition to protection from balance billing for charges above the dentist’s maximum allowable charges. Members utilizing non-participating dentists will have the same benefits but may be subject to balance billing.
Claims Process
In-Network
- Participating Cigna providers file the claim and accept payment from Cigna
- Employees should not need to pay at the time of service for participating providers
Out-of-Network
- For out-of-network dentists, if the dentist does not agree to file the claim as out-of-network with Cigna, employee pays at the time of service and files a claim for reimbursement
- The plan reimburses at a percent Usual and Customary (U&C) for out-of-network providers. Charges by out-of-network providers that exceed U&C are the member’s financial responsibility. (Member pays the difference between the actual charge and the plan’s U&C reimbursement level.)
Cigna Dental Virtual Care
While Cigna recommends contacting your dentist first for your dental care needs, that may not always be possible.
- Virtual care provides convenient access to care for things like toothaches, chipped teeth, and oral infections.
- Speak with a dentist through virtual chat on the mycigna.com portal or the Cigna app.
- Login to your mycigna.com member portal to access this benefit.
Cigna Dental Oral Health Integration Program
This program includes additional preventive care benefits like extra cleanings for dental plan members with specific medical conditions.
- Pregnant members, as well as members with heart disease, stroke, diabetes, maternity, chronic kidney disease, organ transplants, radiation for head or neck cancers, Rheumatoid Arthritis, Sjogren's disease, Lupus, Parkinson's Disease, ALS, Huntington's Disease, and opioid misuse and addiction are eligible.
- How to enroll: Access mycigna.com and register online.
| Cigna Dental Coverage | Standard Plan | Premium Plan |
|---|---|---|
|
Deductible
|
$75 individual | $225 Family | $50 individual | $150 Family |
|
Type A - Preventive Services (Deductible Waived):
Cleanings (regular and periodontal), exams, fluoride, x-rays (including full mouth), sealants and more |
Plan pays 100% | Plan pays 100% |
|
Type B - Basic Services (After Deductible):
Fillings, simple extractions, general anesthesia, periodontal scaling, and root planing |
Plan pays 80% | Plan pays 80% |
|
Type C - Major Services (After Deductible):
Periodontal surgery, major periodontics, bridges, dentures, crowns, and root canals |
Plan pays 50% | Plan pays 50% |
|
Type D - Orthodontia (After Deductible):
Adults and children |
Not Covered | Plan pays 50% |
|
Orthodontia Lifetime Maximum
|
Not Covered | $1,500 per person |
|
Annual Maximum (per person)
|
$1,000 per person | $2,000 per person |
