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Prepared for Detectives' Endowment Association Health Benefits Funds Members
Cigna dental customers have access to programs and services that can help improve whole person health through dental care.
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When you activate your myCigna account, you get access to a personalized experience and tools that can help you maximize your dental plan benefits.
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Cigna DPPO Plan
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We want you to feel comfortable knowing that Cigna is a leading health services company with one mission: to help the people we serve improve their health, well-being and security. We are honored to be providing dental benefits to you and your family.
Welcome, Detectives' Endowment Association Health Benefits Funds Members!
About Cigna
The Cigna Dental Oral Health Integration Program is for customers with certain medical conditions that have been found to be associated with gum disease and other oral health conditions. The Cigna Dental Oral Health Integration Program reimburses out-of-pocket costs for specific dental services used to treat gum disease and tooth decay. There's no additional cost for the program - if you qualify and enroll, you get reimbursed!
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Cigna Dental Oral Health Integration Program
Although the DPPO plans will pay for covered services performed by dentists who do not participate in our network, you may save money by using a dentist who is in network. In-network dentists file claims on your behalf and apply your coinsurance to their fees which are discounted for Cigna customers.
Choice and Savings
With the Total Cigna DPPO network, you'll be able to choose from over 150,000 dentists*. And if you're not sure where to start with your search, we've made it easy with tools on your personalized myCigna account. You can read verified patient reviews, compare Brighter Scores and view office information and photos**.
A Network of Quality Providers
With a Cigna DPPO plan, you don't need to choose a primary dentist for care, and you don't need referrals to visit specialists. And since many dentists offer online appointment scheduling through myCigna, it's easy to make appointments and receive reminders.
Ease and Convenience
Stay healthy from your teeth to your toes.
How your Cigna dental plan can help.
*Cigna Total DPPO network unique provider count for year-end 2020: 151,000 providers in Total DPPO network. Subject to change. **Actual features may vary by dentist. These and other dentist directory features are for educational purposes only and should not be the sole basis for decision making. They are not a guarantee of the quality of care that will be provided to individual patients and you should consider all relevant factors when selecting a dentist.
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Implant Coverage Learn More
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Product availability may vary by location and plan type and is subject to change. All group health insurance policies and health benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company (CHLIC) or its affiliates. Policy forms: OR - HP-POL38 02-13, TN - HP-POL43/HC-CER1V1 et al. (CHLIC). 927583 04/21 ©2021 Cigna. Some content provided under license.
***This listing is not all-inclusive. For a listing of providers and facilities that participate in the LocalPlus network, contact your Cigna representative or visit Cigna.com.
** As of March 2021. Subject to change.
* Potential savings estimated, based on an internal Cigna study conducted in 2021 comparing Cigna’s LocalPlus plans with Cigna’s Open Access Plus (OAP) plans in Georgia with the same benefit plan provisions. Savings are not guaranteed and will vary depending on plan design, geographic distribution and utilization patterns. Medical cost savings do not directly translate to rate or premium rates.
Find a Total DPPO Network Dentist
Your plan has no annual deductible or dollar maximum on covered services. However, it is important to understand how care is covered when you use a network dentist versus a non-network dentist.
Network dentists have agreed to provide dental services to Cigna customers at a reduced rate, saving you money on care. They will file claims for you and they cannot "balance bill" you for the difference between their usual fees and what they have agreed to accept from Cigna. Balance billing occurs when the fee the dentist usually charges is more than the amount Cigna pays them.
Out-of-Network dentists do not offer a reduced rate to Cigna customers and you may have to file your own claims. Out-of-network dentists can charge whatever fee they want for services, but Cigna uses a "maximum allowed amount" to determine the reimbursable fee. The "maximum allowable charge" (MAC) is based on a percentile of fees charged by dentists in an area for a specific service. Out-of-network dentists can balance bill you for the difference between their usual fees and the amount Cigna reimburses them.
Why use a Cigna Total DPPO network dentist?
Show me an example
We're focused on helping you be at your best, body and mind.
Active Member Benefit Summary
Cigna Dental PPO
Plan overview
Routine dental exams can help detect signs of medical conditions such as diabetes, leukemia, heart disease and kidney disease that sometimes produce oral symptoms.
If you have a chronic medical condition such as diabetes, heart disease or a history of stroke, getting the appropriate preventive dental care is even more important, because studies show a connection between certain chronic conditions and gum disease.¹
Having regular preventive dental check-ups can help you avoid emergency room and urgent care visits. People who don't get regular dental care have 22% more visits to emergency rooms and urgent care centers.²
Your Cigna dental plan covers certain preventive dental care services at no additional cost when you use a dentist in the Total DPPO network.³
Bob and Mary both need a root canal.
Mary Out-of-Network Dentist
Bob Network Dentist
Fee for root canal
Percentage of reimbursable fees the plan covers
Reimbursable amount
Plan pays
$850
100%
Contracted Fee $650
MAC $700
$650
$700
Can dentist balance bill?
$150
No
Yes
Mary Pays
$0
Difference between usual fee and MAC.
Bob Pays
Bob uses a network dentist. Mary uses an out-of-network dentist.
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1. "Oral health: A window to your overall health" Mayo Clinic, June 2019 2."Preventive Dental Treatment Associated with Lower Medical Utilization and Costs." National study of Cigna customers with dental and medical coverage, updated December 2020. 3. All group dental insurance policies and dental benefit plans contain exclusions and limitations. For costs and details of coverage, review your plan documents or contact a Cigna representative.
Example for illustrative purposes only.
Retired Member Benefit Summary
Prepared for DEA Members
Q1: Can I go to any dentist? A1: Yes. You will typically spend less when you visit a Cigna network dentist because Cigna has negotiated discounted rates with these dentists. The DEA Fund’s new national dental network is called “Total Cigna DPPO (Cigna DPPO Advantage and Cigna DPPO)”. When you use a Total Cigna DPPO (Cigna DPPO Advantage/Cigna DPPO) network dentist you’ll save as long as the procedure is listed on the dentist’s discount schedule. If you use a non-network dentist, you will not receive Cigna network discounts and the dentist may bill you for the difference between the payment they receive from Cigna and their usual fees. Q2: What if my current dentist does not participate in the Cigna Network? A2: While most in-network dentists currently used by members and their families are part of Cigna’s extensive national network, a small number are not. To address this, Cigna has implemented a focused outreach to have these dentists join its network. You may go to cigna.com to see if your dentist is participating, or you may call Cigna’s dedicated toll free member number at (888) 735-3715. Q3: How are non-network dentists reimbursed under the new Cigna plan? A3: Non-network dentists are reimbursed based on a Maximum Allowable Charge (MAC) schedule. Cigna will reimburse covered services at 100% of the Maximum Allowable Charge. There will be no charge to you if the non-network dentist accepts Cigna’s paid amount as payment in full. However, non-network dentists may balance bill you for the difference between Cigna’s payment and their usual fee. A quick example of how in-network vs non-network dentists are reimbursed is as follows; Q4: Do I choose a dentist when I sign up for the plan? A4: No, you are free to see any network or non-network dentist (general dentist or specialist) without notifying Cigna in advance. You can find a network dentist or specialist online at Cigna.com before you sign up, or go to your personalized website at myCigna.com after you sign up. You can also call Cigna’s 24/7/365 dedicated toll free number at (888) 735-3715, and we will help you find a network dentist in your area. Q5: Do I pay up front and submit a claim or will the dentist submit claims for me? A5: In most instances, if you are using an in-network dentist, they will submit claims on your behalf. Cigna accepts electronic claims from non-network dentists, however a non-network dentist may require you to file your own claims after payment if they choose not to file on your behalf. Q6: Can I download my ID card to my device? A6: Yes. You will be receiving ID cards in the mail; however, once you are registered on the myCigna.com Home page you will see “ID Cards.” The “ID Cards” icon is usually on the bottom left of a smart phone and top right on a computer. Q7: What if it's 3:00am and I urgently need dental care? A7: Virtual dental care is available 24/7/365. You must first log onto myCigna.com to have access to our virtual dental care. Once you are in myCigna.com follow the prompts to the virtual care portal. This will take you to “TheTeleDentists” website where you will need to create an account. Afterwards, you will be able to receive virtual urgent dental care. Please note that the dentist must be able to see you from your device.2 Q8: What are my in-network copays/deductibles/coinsurance? A8: None. You have no copays, deductibles, or coinsurance for in-network coverage. You may have some out-of-pocket costs if you utilize an out-of-network dental provider. Q9: What is my calendar year maximum allowed benefit? A9: The only maximum allowed benefit is for orthodontia, which is a $4,000 lifetime maximum per person. All other benefits are unlimited, subject to applicable plan frequency limits, exclusions and medical necessity provisions. Q10: Do I need a referral to see a dental specialist? A10: No. However we do suggest seeing an in-network dentist, if possible, to save money. Q11: What do I have to do for enrollment? A11: Nothing. Enrollment will be facilitated between the DEA Funds and Cigna. However, please notify the DEA Funds office immediately if you have any change in family status (e.g. marriage, divorce, birth, adoption, etc.) that affects your enrollment status. Q12: Who can I call prior to the 9/1/2021 effective date if I have questions? A12: Cigna has created a dedicated 24/7/365 toll free number that members can call at any time prior to enrollment. The number is: (888) 735-3715. You can also call the DEA Funds office at (212) 587-9120 during normal business hours. Q13: Are there any differences in the dental benefits for Active members and Retirees? A13: No. Both Active members and Retirees have the same exact benefits and the same Cigna dental network. Q14: How many dentists are in the Cigna network? A14: Cigna has over 150,000 dentists in their Total Cigna DPPO (Cigna Advantage DPPO/Cigna DPPO) network. Q15: To what age are dependent children covered? A15: Children are covered until age 19, and full-time students are covered until age 23. Q16: Is orthodontia coverage available to eligible children and adults? A16: Yes. Orthodontia coverage for adults is an enhanced coverage that has been added effective 9/1/2021. Q17: Will I have to give my Social Security number in order to enroll with Cigna? A17: No. Members will be issued a unique ID number instead of a social security number. Your new Cigna Dental unique ID number will look like D32xxxxxx (the last 6 digits will be the same as your dental DEA ID number today). Q18: What is Transition of Care (TOC), and how does Transition of Care work with Cigna? A18: Transition of Care (TOC) allows covered members and their family to continue to receive services for specific procedures during coverage transitions. A TOC service is a dental procedure that begins while you’re covered under one insurance carrier or plan and is finished while you’re covered under a different insurance carrier or plan. Typically, TOC services require more than one trip to the dental office for completion. TOC applies to orthodontic treatment and some general dentistry services, such as root canal therapy, crowns, partials or bridges. Please note that if you are in active treatment for the following: Orthodontia - Benefits for active treatment of orthodontic services will be covered under the new Cigna insurance policy effective 9/1/2021. Please be sure to let your provider know about the change in carrier so they can submit claims directly to Cigna for payment. Other Covered Dental Services - Benefits for dental services rendered prior to 9/1/2021 are the responsibility of the DEA Funds’ current dental plan administrator/insurance carrier, Healthplex. If a claim is denied for services rendered prior to 9/1/2021 or for TOC dental services, please contact the DEA Funds office and they will work with Healthplex and/or Cigna to have the claim reviewed.
Frequently Asked Questions
Have questions? Call Cigna at 888.735.3715
Your new dental plan through Cigna covers services for dental implants. Here are some things you need to know. This year, your dental plan benefits transferred to Cigna. Your new plan includes coverage for services that may not have been available to you in the past. One of those services is dental implants. What are dental implants? The American Academy of Implant Dentistry defines dental implants as “a small post, usually made of titanium, that serves as a substitute for the root of the tooth. A connector, known as an abutment, is placed on, or built into, the top of the dental implant, which connects it to the replacement tooth. Finally, a crown, a replacement tooth, is custom fabricated to match your natural teeth, completing the dental implant.”
Surgical Implant Information
How does my plan cover dental implants? Your plan covers necessary dental implant services at 100%, with no deductible, annual dollar maximum or lifetime maximum. However, there are frequency limits for related services such as the placement of a crown over the implant. This means there may be time or quantity limits – for example, your plan allows the replacement of a crown once every five years per tooth. For more details about limitations and exclusions, please refer to your plan documents or call the DEA Fund Office at 212-587-9120. At the dentist Most dental plans do not cover implants at 100% with no deductible or dollar maximum. Because of this, your dentist may ask you to pay for a portion of the implant cost before the procedure is performed. Although we have distributed a communication to network dentists in your area advising them of your plan coverage, there may still be instances where they are unsure or unaware of the rich implant benefits on your plan. If this happens, please direct them to Cigna provider relations or call Cigna at 1-888-735-3715. If you are using a network dentist, you are not required to pay anything ahead of the service. Out-of-network dentists can charge you the full cost before or after the procedure which means you would need to file the claim with Cigna. Planning for care As with any costly dental procedure, we always recommend asking your network dentist to get a pre-treatment estimate from Cigna. This is a process whereby the dentist submits the planned procedure codes and charges to Cigna before care is provided. Cigna reviews the submission and provides a response within 12-15 days that shows what is or isn’t covered and what your costs will be. Pre-treatment estimates help ensure you don’t have costly services performed only to find out something is not covered. Although pre-treatment estimates are not required, we do recommend working with your dentist to obtain one for services in excess of $200. The pre-treatment review will also show the dentist how much they will be paid. This way they know exactly how much to charge you if there are any out-of-pocket costs for the services you’ll be receiving. We’re here to help If you have questions about your plan or need assistance, contact us anytime at 1-888-735-3715.
