Dental Benefits

Like brushing and flossing, visiting your dentist is an essential part of your oral health. Willow Bridge offers affordable plan options from Cigna for routine care and beyond.

Cigna Core Dental Plan Premiums

Coverage Tier	SEMI-MONTHLY	BI-WEEKLY	WEEKLY
Employee Only	$15.00	$13.85	$6.92
Employee + Spouse	$27.50	$25.38	$12.69
Employee + One Child	$22.50	$20.77	$10.38
Employee + Two or More Children	$32.50	$30.00	$15.00
Employee + Family	$37.50	$34.62	$17.31

Coverage TierEmployee Only

SEMI-MONTHLY: $15.00
BI-WEEKLY: $13.85
WEEKLY: $6.92

Coverage TierEmployee + Spouse

SEMI-MONTHLY: $27.50
BI-WEEKLY: $25.38
WEEKLY: $12.69

Coverage TierEmployee + One Child

SEMI-MONTHLY: $22.50
BI-WEEKLY: $20.77
WEEKLY: $10.38

Coverage TierEmployee + Two or More Children

SEMI-MONTHLY: $32.50
BI-WEEKLY: $30.00
WEEKLY: $15.00

Coverage TierEmployee + Family

SEMI-MONTHLY: $37.50
BI-WEEKLY: $34.62
WEEKLY: $17.31

Cigna Buy-Up Dental Plan Premiums

Coverage Tier	SEMI-MONTHLY	BI-WEEKLY	WEEKLY
Employee Only	$21.07	$19.45	$9.72
Employee + Spouse	$39.04	$36.03	$18.02
Employee + One Child	$31.61	$29.18	$14.59
Employee + Two or More Children	$46.48	$42.90	$21.45
Employee + Family	$53.89	$49.74	$24.87

Coverage TierEmployee Only

SEMI-MONTHLY: $21.07
BI-WEEKLY: $19.45
WEEKLY: $9.72

Coverage TierEmployee + Spouse

SEMI-MONTHLY: $39.04
BI-WEEKLY: $36.03
WEEKLY: $18.02

Coverage TierEmployee + One Child

SEMI-MONTHLY: $31.61
BI-WEEKLY: $29.18
WEEKLY: $14.59

Coverage TierEmployee + Two or More Children

SEMI-MONTHLY: $46.48
BI-WEEKLY: $42.90
WEEKLY: $21.45

Coverage TierEmployee + Family

SEMI-MONTHLY: $53.89
BI-WEEKLY: $49.74
WEEKLY: $24.87

Covered Services

Services	Core Plan In-Network and Out-of-Network	Buy-Up Plan In-Network and Out-of-Network
Annual Deductible - Individual	$75	$75
Annual Deductible - Family	$225	$225
Annual Maximum - per Person	$1,500	$3,000
PREVENTIVE SERVICES Oral Exams, Routine Cleanings, Bitewing X-rays, Fluoride Applications, Sealants, Space Maintainers, Panoramic X-rays	0% (Covered at 100%)	0% (Covered at 100%)
BASIC SERVICES Full Mouth X-rays, Fillings, Oral Surgery, Simple Extractions	20%*	20%*
MAJOR SERVICES Oral Surgery, Complex Extractions, Denture Adjustments and Repairs, Root Canal Therapy, Periodontics, Crowns, Dentures, Bridges	50%*	50%*
ORTHODONTICS Children and Adults	50%	50%
Orthodontic Lifetime Maximum	$2,500	$5,000

ServicesAnnual Deductible - Individual

Core Plan In-Network and Out-of-Network: $75
Buy-Up Plan In-Network and Out-of-Network: $75

ServicesAnnual Deductible - Family

Core Plan In-Network and Out-of-Network: $225
Buy-Up Plan In-Network and Out-of-Network: $225

ServicesAnnual Maximum - per Person

Core Plan In-Network and Out-of-Network: $1,500
Buy-Up Plan In-Network and Out-of-Network: $3,000

ServicesPREVENTIVE SERVICES Oral Exams, Routine Cleanings, Bitewing X-rays, Fluoride Applications, Sealants, Space Maintainers, Panoramic X-rays

Core Plan In-Network and Out-of-Network: 0% (Covered at 100%)
Buy-Up Plan In-Network and Out-of-Network: 0% (Covered at 100%)

ServicesBASIC SERVICES Full Mouth X-rays, Fillings, Oral Surgery, Simple Extractions

Core Plan In-Network and Out-of-Network: 20%*
Buy-Up Plan In-Network and Out-of-Network: 20%*

ServicesMAJOR SERVICES Oral Surgery, Complex Extractions, Denture Adjustments and Repairs, Root Canal Therapy, Periodontics, Crowns, Dentures, Bridges

Core Plan In-Network and Out-of-Network: 50%*
Buy-Up Plan In-Network and Out-of-Network: 50%*

ServicesORTHODONTICS Children and Adults

Core Plan In-Network and Out-of-Network: 50%
Buy-Up Plan In-Network and Out-of-Network: 50%

ServicesOrthodontic Lifetime Maximum

Core Plan In-Network and Out-of-Network: $2,500
Buy-Up Plan In-Network and Out-of-Network: $5,000

*After deductible

Plan Notes

If your dentist doesn’t participate in your plan’s network, your out-of-pocket costs will be higher, and you are subject to any charges beyond the Reasonable and Customary (R&C). To find a network dentist, visit Cigna at www.mycigna.com