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DENTAL PLAN
Delta Dental Summary Plan [PDF]
Delta Dental Provider Search
Delta Dental Base Certificate of Coverage [PDF]
Delta Dental Low Option Certificate of Coverage [PDF]
Delta Dental High Option Certificate of Coverage [PDF]
Delta Dental Additional Cleanings for Members with Specific Conditions [PDF]
CIGNA DHMO Schedule of Fees [PDF]
CIGNA DHMO Provider Search
For more information please call Employee Benefits at 215-2111.
The City provides all benefits-eligible employees with a free annual exam, cleaning and one set of bite-wing x-rays per year, at no cost when you visit a Delta Dental provider.

Employees also have the option purchase more comprehensive dental coverage for themselves and their families.

Choose from:

  • A low dental option, provided through Delta Dental
  • A high dental option including orthodontia, provided through Delta Dental
  • A dental HMO (DHMO), provided through CIGNA

    Delta Dental High and Low Options

    Whether you elect the Low or the High option, you are free to visit any provider you choose. The benefit percentages are the same for in and out of network, but the difference is you could be balance billed if you see a non-network provider. Delta Dental has two large networks for you to choose from: PPO and Premier. Whether you enroll in the High or the Low plan, you may use either network. The difference is you'll see greater discounts from the PPO network (which means less out of pocket expenses for you)! As long as you use a dentist in Delta Dental's PPO or Premier networks, you will not be billed for charges exceeding the maximum plan allowance. See the chart and footnotes below, or visit http://knoxville.deltadentaltn.com. Use this website also to locate network providers.

    In addition, both options cover additional exams/cleanings (up to four per year) for diabetics and pregnant women with periodontal disease, individuals with renal failure or suppressed immune systems, head and neck radiation patients, and individuals at risk for infective endocarditis.

    CIGNA DHMO Option

    If you choose the DHMO, you must use a CIGNA network dentist to receive benefits. CIGNA's plan does not allow for out of network dental benefits. Their dental network is small, but their premiums are low with attractive copays for services. Visit www.cigna.com (if not enrolled) or www.mycigna.com (if enrolled) to search for providers.

    Dental Options at a glance:

      Delta Dental Low Option (1) Delta Dental High Option (1) CIGNA
    DHMO
    YOU PAY
    Calendar Year Deductible $50/individual $150/family $50/individual $150/family $0
    THEN THE PLAN PAYS
    Preventive care (exams, x-rays, cleanings) 100%
    no deductible
    Does not apply towards Annual Max
    100%
    no deductible
    Does not apply towards Annual Max
    $0 copay (2)
    Basic care (fillings) 80%
    after deductible
    80%
    after deductible
    See charge schedule
    Major care (crowns, dentures, bridges oral surgery, endo and perio) 50%
    after deductible
    50%
    after deductible
    See charge schedule
    Orthodontia None 50%
    no deductible
    Child only to age 19
    See charge schedule (adults and children)
    Annual benefit maximum (3) $1,000 $1,500 N/A
    Orthodontia lifetime maximum N/A $1,500 N/A

    (1) Providers in Delta Dental's PPO and Premier Network have agreed not to exceed the maximum plan allowance (MPA). If you use providers outside these networks you're responsible for charges exceeding the MPA. (2) The CIGNA DHMO covers up to four annual cleanings (two at 100% and two at a low scheduled cost). See the charge schedule for details. (3) Once Basic or Major charges reach the annual benefit maximum, no further benefits are payable for the remainder of the plan year, but you may still access the in-network discounts with Delta Dental.

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