Cigna Dental Care^® (DHMO) Insurance Plan

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¹The term “DHMO” is used to refer to product designs that can vary depending on your state, including but not limited to, prepaid plans, managed care plans and plans with open access features. The Cigna Dental Care plan is not available in all states.

²A benefit is paid for covered out-of-network emergency dental care. Certain states mandate coverage for dental care received out-of-network. For example, in Minnesota, the plan will pay 50% of the value of your network benefit for covered out-of-network services. In Oklahoma, the plan will pay the same amount it pays network dentists for covered out-of-network services. You are responsible for any charges not covered by the plan. Other states may have similar mandates. Refer to your plan documents for cost and coverage details.

³Please refer to your plan documents or contact your employer for more information on what out-of- pocket costs you may be responsible for and what’s covered and not covered by your employer’s specific plan.

⁴ Network360 data as of September 2021: Cigna Dental Care Access Plus network as compared to competitor national DHMO networks. Network360 makes no warranty regarding the performance of the data and the results that will be obtained by using.

⁵ Not all preventive care services are covered. For example, prescription medications are generally not covered. Most plans limit cleanings and bitewing x-rays to two (2) per calendar year, and full mouth/panorex x-rays to one (1) every three calendar years. Plans may vary so see your Dental Fee Overview for a summary of covered preventive care services.

⁶Refer to your plan materials to see if your plan includes orthodontic coverage. The following orthodontic services are generally not covered: incremental costs associated with optional/elective materials; orthognathic surgery appliances to guide minor tooth movement or correct harmful habits; and any services which are not typically included in orthodontic treatment.

⁷Customers under age 13 (and/or their parent/guardian) will not be able to register at myCigna.com.

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, review your plan documents or contact a Cigna Healthcare representative.

All Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group Corporation, including Cigna Health and Life Insurance Company (CHLIC), Connecticut General Life Insurance Company, 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.