◄Back To The Comparison Center

These Exclusions Are For The Following myCigna Dental Plans

All of these plans are Dental Indemnity Insurance

1. Procedures which are not included in the list of covered dental expenses.
2. Procedures which are not necessary and which do not have uniform professional endorsement.
3. Procedures for which a charge would not have been made in the absence of coverage or for which the covered person is not legally required to pay.
4. Any procedure, service, supply or appliance, the sole or primary purpose of which relates to the change or maintenance of vertical dimension.
5. Procedures, appliances or restorations whose main purpose is to diagnose or treat jaw joint problems, including dysfunction of the temporomandibular joint and craniomandibular disorders, or other conditions of the joints linking the jawbone and skull, including the complex muscles, nerves and other tissues related to that joint. (Services are applicable in AR, MN, NM, NV, NY, UT, and VT)
6. The alteration or restoration of occlusion.
7. The restoration of teeth which have been damaged by erosion, attrition or abrasion.
8. Bite registration or bite analysis.
9. Any procedure, service or supply provided primarily for cosmetic purposes. Facings, repairs to facings or replacement of facings on crowns or bridge units on molar teeth shall always be considered cosmetic.
10. The initial placement of a full denture or partial denture unless it includes the replacement of a functioning natural tooth extracted while the person is covered under this plan (the removal of only a permanent third molar will not qualify a full or partial denture for benefit under this provision).
11. The initial placement of a fixed bridge, unless it includes the replacement of a functioning natural tooth extracted while the person is covered under this plan. If a bridge replaces teeth that were missing prior to the date the person’s coverage became effective and also teeth that are extracted after the person’s effective date, benefits are payable only for the pontics replacing those teeth which are extracted while the person was insured under this plan. The removal of only a permanent third molar will not qualify a fixed bridge for benefit under this provision.
12. The initial placement of an implant unless it includes the replacement of a functioning natural tooth extracted while the person is covered under this pThe removal of only a permanent third molar will not qualify an implant for benefit under this provision.
    Unless you have a tooth extracted while insured by this company, there is no benefit for any prosthetic appliance (dentures or partials) or fixed partial denture (bridges).  Items 10,11 & 12
    
    
13. The surgical placement of an implant body or framework of any type; surgical procedures in anticipation of implant placement; any device, index or surgical template guide used for implant surgery; treatment or repair of an existing implant; prefabricated or custom implant abutments; removal of an existing implant.
14. Crowns, inlays, cast restorations, or other laboratory prepared restorations on teeth unless the tooth cannot be restored with an amalgam or composite resin filling due to major decay or fracture.
15. Core build-ups.
16. Replacement of a partial denture, full denture, or fixed bridge or the addition of teeth to a partial denture unless:
    • Replacement occurs at least 84 consecutive months after the initial date of insertion of the current full or partial denture; or
    • The partial denture is less than 84 consecutive months old, and the replacement is needed due to a necessary extraction of an additional functioning natural tooth while the person is covered under this plan (alternate benefits of adding a tooth to an existing appliance may be applied); or
    • Replacement occurs at least 84 consecutive months after the initial date of insertion of an existing fixed bridge (if the prior bridge is less than 84 consecutive months old, and replacement is needed due to an additional necessary extraction of a functioning natural tooth while the person is covered under this plan. Benefits will be considered only for the pontic replacing the additionally extracted tooth).
17. The removal of only a permanent third molar will not qualify an initial or replacement partial denture, full denture or fixed bridge for benefits.
18. The replacement of crowns, cast restoration, inlay, onlay or other laboratory prepared restorations within 84 consecutive months of the date of insertion.
19. The replacement of a bridge, crown, cast restoration, inlay, onlay or other laboratory prepared restoration regardless of age unless necessitated by major decay or fracture of the underlying natural tooth.
20. Any replacement of a bridge, crown or denture which is or can be made useable according to common dental standards.
21. Replacement of a partial denture or full denture which can be made serviceable or is replaceable.
22. Replacement of lost or stolen appliances.
23. Replacement of teeth beyond the normal complement of 32.
24. Prescription drugs.
25. Any procedure, service, supply or appliance used primarily for the purpose of splinting.
26. Athletic mouth guards.
27. Myofunctional therapy.
28. Precision or semi-precision attachments.
29. Denture duplication.
30. Separate charges for acid etch.
31. Labial veneers (laminate).
32. Porcelain or acrylic veneers of crowns or pontics on, or replacing the upper and lower first, second and third molars.
33. Precious or semi-precious metals for crowns, bridges, pontics and abutments; crowns and bridges other than stainless steel or resin for participants under 16 years old.
34. Treatment of jaw fractures and orthognathic surgery.
35. Orthodontic treatment, except for the treatment of cleft lip and cleft palate. Exclusion does not apply if the plan otherwise covers services for orthodontic treatment. (Services are applicable in CO, IN, MN, SC, and VA)
36. Charges for sterilization of equipment, disposal of medical waste or other requirements mandated by OSHA or other regulatory agencies and infection control.
37. Charges for travel time; transportation costs; or professional advice given on the phone.
38. Temporary, transitional or interim dental services.
39. Any procedure, service or supply not reasonably expected to correct the patient’s dental condition for a period of at least three years, as determined by Cigna.
40. Diagnostic casts, diagnostic models or study models.
41. Any charge for any treatment performed outside of the United States other than for emergency treatment (any benefits for emergency treatment which is performed outside of the United States will be limited to a maximum of $100 per consecutive 12-month period).
42. Oral hygiene and diet instruction; broken appointments; completion of claim forms; personal supplies (water pick, toothbrush, floss holder); duplication of x-rays and exams required by a third party.
43. Any charges, including ancillary charges, made by a hospital, ambulatory surgical center or similar facility.
44. Services that are deemed to be medical services.
45. Services for which benefits are not payable according to the “general limitations” section.

• No payment will be made for expenses incurred for you or any one of your dependents:

1. For services not specifically listed as covered services in this policy.
2. For services or supplies that are not dentally necessary.
3. For services received before the effective date of coverage.
4. For services received after coverage under this policy ends.
5. For services for which you have no legal obligation to pay or for which no charge would be made if you did not have dental insurance coverage.
6. For professional services or supplies received or purchased directly or on your behalf by anyone, including a dentist from any of the following:
   • Yourself or your employer.
   • A person who lives in the insured person’s home, or that person’s employer.
   • A person who is related to the insured person by blood, marriage or adoption, or that person’s employer.
7. For or in connection with an Injury arising out of, or in the course of, any employment for wage or profit.
8. For or in connection with a sickness which is covered under any workers’ compensation or similar law.
   Since Savon is not Insurance, if you have workers' compensation or are self-employed, you are still entitled to your Savon benefits.
   
   
9. For charges made by a hospital owned or operated by or which provides care or performs services for the United States Government, if such charges are directly related to a military-service-connected condition.
10. Services or supplies received as a result of dental disease, defect or injury due to an act of war, declared or undeclared.
11. To the extent that payment is unlawful where the person resides when the expenses are incurred.
12. For charges which the person is not legally required to pay.
13. For charges which would not have been made if the person had no insurance.
14. To the extent that billed charges exceed the rate of reimbursement as described in the schedule.
15. For charges for unnecessary care, treatment or surgery.
16. To the extent that you or any of your dependents is in any way paid or entitled to payment for those expenses by or through a public program, other than Medicaid.
17. For or in connection with experimental procedures or treatment methods not approved by the American Dental Association or the appropriate dental specialty society.
18. Procedures that are a covered expense under any other dental plan which provides dental benefits.
19. To the extent that benefits are paid or payable for those expenses under the mandatory part of any auto insurance policy written to comply with a “no-fault” insurance law or an uninsured motorist insurance law. Cigna will take into account any adjustment option chosen under such part by you or any one of your dependents.