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Cigna Dental Care (DHMO¹) Plan Cigna Dental DPPO Plan Cigna Dental Oral Health Integration Program

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Cigna Dental Care (DHMO) Plan

Cigna DPPO Plan

Offered by Cigna Health and Life Insurance Company, or its affiliates.

Oral Health Integration Program

You can save up to $549 per year* on your dental premiums by enrolling in the DHMO plan! Bi-weekly Rates Employee Only: $3.00 Employee +child(ren): $6.57 Employee + spouse: $5.52 Employee + family: $9.87

No annual deductible to pay No annual dollar maximum on covered care Many preventive care services covered at 100% Orthodontics for the whole family - no lifetime dollar maximum Surgical implants Custom athletic mouth guards Teeth whitening

Features²

Predictable costs plus coverage for some services not available on the DPPO plan².

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Cigna Dental Care (DHMO¹) Plan

Dental Fee Overview

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Video - How a DHMO Plan Works

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View the Dental Fee Overview for a list of the most common covered services and information about what you'll pay for care.³

1. The term “DHMO” is used to refer to product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans, managed care plans, and plans with open access features. The Cigna Dental Care (DHMO) may not be available in all states. 2. All group dental plans and insurance policies have exclusions and limitations. For costs and details about the services covered under your plan, review your enrollment materials. Dentists who participate in Cigna’s network are independent contractors solely responsible for the treatment provided and are not agents of Cigna. 3. This is not a complete list. Actual terms of coverage may vary by state. Exclusions and limitations apply. For a more complete list of both covered and not covered services, including benefits required by your state, refer to the rest of your enrollment materials or call 800.Cigna24 (800.244.6224) if you have questions or need more information. Product availability may vary by location and plan type and is subject to change. All group dental insurance policies and dental benefit plans contain exclusions and limitations. For costs and details of coverage, contact a Cigna representative. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries, including Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (KS & NE), Cigna Dental Health of Kentucky, Inc. (KY & IL), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. CHLIC policy forms: OK – HP-POL99/HP-POL-388, POL115; OR - HP-POL68/HP-POL352, HP-POL121 04-10; TN – HP-POL69/HC-CER2V1/HP-POL389, et al., HP-POL134/HC-CER17V1 et al. © 2023 Cigna

*Annual savings reflective of premiums for buy-up DPPO plan for associate + family as compared to DHMO premiums for associate + family.

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Cigna Dental Care (DHMO) Plan

Cigna DPPO Plan

Oral Health Integration Program

Monthly Premiums

Choose to save by using a network dentist, or maximize flexibility with a plan that allows you to use any dentist for care.

Features¹

$50 per person or $150 per family annual deductible Annual dollar maximum of $2,500 Many preventive care services covered at 100%² Orthodontia for the whole family - $2,000 lifetime maximum² Surgical implants

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Cigna Dental PPO Plan

Video - How a DPPO Plan Works

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Benefit Summary

1. All group dental plans and insurance policies have exclusions and limitations. For costs and details about the services covered under your plan, review your enrollment materials. Dentists who participate in Cigna’s network are independent contractors solely responsible for the treatment provided and are not agents of Cigna. 2. Exclusions and limitations apply. Out-of-network dentists can bill you for the difference between what Cigna pays for covered services and what their usual fee is. For a more complete list of both covered and not covered services, including benefits required by your state, refer to the rest of your enrollment materials or call 800.Cigna24 (800.244.6224) if you have questions or need more information. Product availability may vary by location and plan type and is subject to change. All group dental insurance policies and dental benefit plans contain exclusions and limitations. For costs and details of coverage, contact a Cigna representative. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Connecticut, Inc., and Cigna Dental Health, Inc. and its subsidiaries, including Cigna Dental Health Plan of Arizona, Inc., Cigna Dental Health of California, Inc., Cigna Dental Health of Colorado, Inc., Cigna Dental Health of Delaware, Inc., Cigna Dental Health of Florida, Inc., a Prepaid Limited Health Services Organization licensed under Chapter 636, Florida Statutes, Cigna Dental Health of Kansas, Inc. (KS & NE), Cigna Dental Health of Kentucky, Inc. (KY & IL), Cigna Dental Health of Maryland, Inc., Cigna Dental Health of Missouri, Inc., Cigna Dental Health of New Jersey, Inc., Cigna Dental Health of North Carolina, Inc., Cigna Dental Health of Ohio, Inc., Cigna Dental Health of Pennsylvania, Inc., Cigna Dental Health of Texas, Inc., and Cigna Dental Health of Virginia, Inc. CHLIC policy forms: OK – HP-POL99/HP-POL-388, POL115; OR - HP-POL68/HP-POL352, HP-POL121 04-10; TN – HP-POL69/HC-CER2V1/HP-POL389, et al., HP-POL134/HC-CER17V1 et al. © 2023 Cigna

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Bi-weekly Rates Employee only: $10.39 Employee + Child(ren): $26 Employee + Spouse: $25 Employee + Family: $31

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Cigna Dental Care (DHMO) Plan

Cigna DPPO Plan

Oral Health Integration Program

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