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Dental Insurance

 

Cigna Dental Care® 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 website https://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. 
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MetLife Dental Preferred Provider Organization (DPPO)

  • You can use any Dentist, but you receive maximum benefits when visiting an in-network MetLife DPPO provider for the state's dental plan. The list of providers in the MetLife DPPO network for the state may be found by visiting the website https://www.metlife.com/stateoftn/.
  • Deductible applies for Basic and Major dental care.
  • You pay coinsurance for Basic, Major, Orthodontic and out-of-network covered services.
  • You or your Dentist will file claims for covered services.
  • Some services (e.g., crowns, dentures, implants and complete or partial dentures) require a six-month Waiting Period from the member’s coverage start date before benefits begin.
  • There is a 12-month Waiting Period from the member’s coverage start date for both the replacement of a missing tooth and also Orthodontics.
  • Referrals to Specialists are not required.
  • Pre-treatment estimates are recommended for more expensive services.
  • Dental treatment in progress at time of member’s effective date with MetLife may have pro-rated benefits under the MetLife plan. MetLife has transition-of-care guidelines for participants whose dental treatment is in progress during the benefit plan transition to MetLife. 
  • You pay coinsurance for many covered services and your share is based on the "maximum allowable charge" (MAC) for a given service. MAC is the lesser of the amount charged by the dentist or the maximum payment amount that in-network dentists have agreed to accept in full for the dental service. When you receive dental services from an out-of-network provider, MetLife will reimburse a percentage of the MAC. You are then responsible for paying everything over the percentage of MAC reimbursed up to the charge submitted by the out-of-network dentist. Out-of-network providers typically charge more than the allowable charge, resulting in higher costs for you.
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