Here’s something to smile about: State Farm offers a Cigna dental PPO available to all employees, plus an HMO for employees located in Atlanta, Dallas, Phoenix, or Seattle–Tacoma.
Plan highlights
The Dental PPO and HMO plans both cover preventive care at no cost to you. The plans differ in provider choice, annual maximum benefit, and what you pay out of pocket for dental services.
Dental PPO Plan
Under the PPO Plan, you can receive care from any dentist, but you’ll pay less and your annual coverage will go further when you use an in-network dentist. That’s because network providers all accept negotiated fee discounts.
You’ll pay for this plan through paycheck deductions, and you’ll pay coinsurance for the dental services you receive.
Dental HMO Plan
Available only in some zip codes, this plan requires that you receive care from in-network providers. State Farm covers 100% of the cost of premiums for all coverage tiers, and there’s no annual deductible or annual maximum benefit under this plan. You’ll pay fixed copays for services based on procedure codes. For plan details, review the DHMO brochure.
Plans at a glance
Here’s what you’ll pay for in-network dental care under each plan.
| Feature | Dental PPO: In-network | Dental PPO: Out-of-network | Dental HMO |
|---|---|---|---|
| Provider choice | Any | Any | In-network only |
| Deductible | Individual: $50 Family: $150 | Individual: $50 Family: $150 | None |
| Preventive care (routine cleaning, X-rays, oral exams, topical fluoride) | Covered at 100% | Covered at 100%1 | No charge |
| Basic services (fillings, extractions, etc.) | You pay 20% after deductible | You pay 20% after deductible1 | Fixed fee2 |
| Major restoration care (crowns, onlays, bridges, dentures, implants) | You pay 50% after deductible | You pay 50% after deductible1 | Fixed fee2 |
| Orthodontia | You pay 50%, up to $1,750 lifetime maximum | You pay 50%, up to $1,750 lifetime maximum1 | Fixed fee; no lifetime maximum2 |
| Annual benefit maximum | $1,750 | $1,750 | None |
1Cigna Dental will reimburse according to the maximum reimbursable charge (MRC), which is calculated at the 90th percentile of reasonable and customary allowances. You will be responsible for paying any difference between what Cigna reimburses and the out-of-network provider’s usual fee.
2Fixed fees for covered services are based on procedure codes as listed in the Patient Charge Schedule.
Discounts and savings
The Oral Health Integration Program (OHIP) fully covers additional services for Dental PPO participants with qualifying medical conditions, including diabetes, maternity, cardiovascular disease, head and neck cancer radiation treatment, organ transplants, and chronic kidney disease.
- Participants receive 100% reimbursement for extra cleanings, exams, and fluoride treatment, and the deductible doesn’t apply to these services.
- Participants pay no additional cost for the program.
- Reimbursements count toward the annual benefit maximum.
To participate in the OHIP program, complete and submit the registration form.