Citi Benefits Handbook
Dental Options at a Glance
Which Dental Plan Is Right for You?
View this short benefits video to help you choose the right plan for you and your family during Annual Enrollment or as a new hire.
 
MetLife Preferred Dentist Program (PDP)1
Cigna Dental HMO2
Annual Deductible
   
• Individual
$50
None
• Family maximum
$150
None
Preventive and diagnostic services
100% paid; no deductible to meet
Most services are paid at 100% when you use your network dentist
Basic services such as fillings, amalgams (silver) and composite (white) filings, root canals, periodontal services, extractions and oral surgery
80% after deductible
Copay when you use your network dentist. See "Patient Charge Schedule" for more information.
Major restorative services such as crowns, inlays/onlays, bridges and dentures
50% after deductible
Copay when you use your network dentist. See "Patient Charge Schedule" for more information.
Orthodontia
50% after deductible
Copay when you use your network dentist. See "Patient Charge Schedule" for more information.
Lifetime orthodontia limit for children and adults
$3,000 per person
Coverage limited to 24 months of treatment
Temporomandibular joint (TMJ) treatment excluding surgery
50% after deductible if not the result of an accident (covered under orthodontia)
100% paid for oral evaluation; copay for other related services when you use your network dentist
Implants
Subject to "dental necessity"
Copay when you use your network dentist. Limit of one implant per calendar year, with one replacement per 10 years
Annual maximum
$3,000 per person
None
1 MetLife PDP providers charge negotiated fees for services. For services other than those for preventive care, you must meet the annual deductible before the Plan will pay a percentage of eligible costs. Benefit amounts for out-of-network dentists are based on the maximum allowed amount for your geographic area.
2 You can obtain a schedule of charges and a list of providers by calling Cigna Dental HMO at 1 (800) Cigna 24
(1 (800) 244-6224)
. Once enrolled, you can obtain a schedule of charges at www.myCigna.com. You can also view the Cigna Patient Charge Schedule at citibenefitsonline.com/SiteCollectionDocuments/CignaDentalPatientChargeSchedule.pdf.