Cigna Dental Care® Health Maintenance Organization (HMO) Prepaid Plan
You must select a Network General Dentist (NGD) from the Prepaid (DHMO) Dental Plan list for the state’s dental plan and let Cigna
know of your choice. The list of providers in the Cigna network for the state may
be found by visiting the websitehttps://www.cigna.com/sites/stateoftn/.
You must use your selected dentist to receive benefits.
You may select a network Pediatric Dentist as the Network General Dentist (NGD) for
your dependent child under age 13. At age 13, you must switch the child to a NGD or
pay the full charge from the pediatric dentist.
There may be some areas in the state where NGDs are limited or not available. Before
enrolling, carefully check the network for your location.
With the prepaid dental plan, you may be able to cancel this coverage if you enroll
and later there are no NGDs within a 25-mile radius of your home.
You pay copays for dental treatments, and they may have changed for dental procedures.
No deductibles to meet, no claims to file, no waiting periods, no annual dollar maximum.
Preexisting conditions are covered.
Referrals to Specialists are required.
Dental implants will be covered. Limited to one implant per calendar year, with a
replacement of one every 10 years.
Orthodontic treatment is not covered if the treatment plan began prior to the member’s
effective date of coverage with Cigna.
The completion of crowns, bridges, dentures, or root canal treatment already in progress
on the member’s effective date of coverage is also not covered.
You can use any dentist, but you receive maximum benefits when visiting an in-network DPPO provider for the
state's dental plan. Review Delta Dental’s DPPO network (coming soon).
You pay deductibles and co-insurance for some dental care. Deductible does not apply
to diagnostic and preventive benefits such as periodic oral evaluation.
You or your dentist will file claims for covered services. Discuss any estimated expenses
with your dentist or specialist. Charges for dental procedures are subject to change.
Waiting periods apply for some services (e.g., crowns, dentures, implants and complete
or partial dentures) from the member’s coverage start date before benefits begin.
Teledentistry is offered and claims are handled as if the patient received dental
services in a dental office. Charges are considered as Type A: Diagnostic and Preventive
and are subject to frequency limitations.
There is a 12-month waiting period from the member’s coverage start date that applies
to dentures and implants to replace one or more natural teeth.
Referrals to specialists are not required.
Dental treatment in progress at time of member’s effective date with Delta Dental
may have pro-rated benefits under the Delta Dental plan. If you are currently enrolled
in the State’s MetLife DPPO plan, Delta Dental will work with your dentist to ensure
you continue to receive the benefits that are covered. For ortho claims, ask your
orthodontist or dental office to submit a claim with the total fee, initial banding
date, and total number of months of treatment. This detail will allow us to calculate
what we can pay.
Time enrolled in the MetLife DPPO for the State Group Insurance Program will count
toward waiting periods under the Delta Dental DPPO contract.
See the Certificate of Coverage for coverage details.COMING SOON!
You pay coinsurance for many covered services and your share is based on the provider
negotiated fee, or PNF agreed upon by the provider and Delta Dental of Tennessee.
The PNF is the highest dollar amount of reimbursement for specific dental procedures
provided by Delta Dental DPPO in-network providers. The in-network dentists have agreed
to not charge members or the plan more than the PNF. When a member receives dental
services from an out-of-network provider, the out-of-network dentist will be paid
by the plan for covered procedures according to the average PNF for in-network providers
and respective plan coinsurance. The member then is responsible for all other charges
by the out-of-network dentist.
