As of 7/1/2014, the State of CT has all of their employee dental insurance plans with Cigna. We are in network with the new Cigna Basic and Cigna Enhanced Dental Insurance plans.
At our office you’ll never have to pay a penny for a cleaning, exam, or routine x-rays!
We have hundreds of patients who work for the State of Connecticut or who have dental insurance benefits through a spouse or parent employed with the State of CT. Our administrative and clinical teams have years of experience with the “ins and outs” of the specialized State of CT plans. We created this page to inform existing and future patients about their options.
Dental Insurance Plans for State Employees
State employees have the option of three basic dental plans (as of 7/1/2014):
- Cigna Basic
- Cigna Enhanced
- Cigna DHMO
As an office, we participate with Cigna Basic and Cigna Enhanced just like we participated with UHC Enhanced and Basic. Patients have been and will continue to experience excellent dental care at our office with those two plans. We do not participate with the DHMO plan because it is significantly different than the Basic and Enhanced Plans.
We have numerous patients from the greater New Haven area with both the Basic and Enhanced plans. Patients are able to use their dental insurance benefits to their maximum because we are in-network. All of our claims are submitted electronically, so Cigna will know within 24 hours of when dental care is rendered in our office in Orange, CT.
Cigna Basic vs. Cigna Enhanced
There are some important differences between the two plans. These include:
- The Enhanced Plan contains coverage for dental implants while the Basic does not.
- The Basic Plan has an unlimited yearly maximum while the Enhanced has a $3,000 maximum per year.
- Both plans cover preventative care (regular cleanings, x-rays, and exams) at 100%.
- The Basic Plan offers better out of network coverage than the Enhanced Plan.
- The Enhanced Plan offers coverage for bridges, dentures, and orthodontia while the Basic Plan does not.
- And many others
Note: the above information is based on publicly available information published both on cigna.com as well as the ct.gov site. You may always refer to those resources should you need additional clarification.
Penalty for Not Receiving Routine Dental Care
As part of legislation passed in 2011, many State of Connecticut employees are subject to a penalty if they do not receive routine dental care. What does this mean for dentist visits and how does this work?
- State of CT employees and family members are encouraged to enroll in the Health Enhancement Program (HEP). If you do not enroll in the HEP, your premiums will be $100 higher per month and you will be subject to $350 per individual ($1,400 per family) annual in-network medical deductible.
- As a result, nearly all employees and their families enroll in the HEP.
- For those employees enrolled in the HEP, there is a requirement for annual dental cleanings. All of the dental plans cover at least two dental cleanings per year.
- If you are enrolled in the HEP and do not receive annual cleanings, then you are subject to penalties.
If you are enrolled in the HEP and do not have a regular dentist, we can help. As in-network dentists with Cigna Enhanced and Basic, we are familiar with the necessary forms and claim submission process to ensure you do not get hit with the fine.
Note: the above information is summarized from documentation posted on the ct.gov site. The source document is located here.
What’s all the fuss about DMO/DHMO Plans?
We have seen dozens of patients who initially selected various DHMO/DMO dental insurance plans from all types of insurance companies but then had negative experiences at other dentist offices. They then switched to more traditional plans and were treated by us. Some observations we have made about DHMO/DMO offices include:
- There are very few DHMO offices in Connecticut so your selection as a patient is very limited. In nearly all cases, you do not have coverage to see general dentists or specialists who do not participate.
- The plans are often presented as having many procedures covered with no deductibles while in reality there are significant co-pays associated with nearly all treatment.
- In many towns in CT, there are either no DMO/DHMO offices, or the only ones are “Corporate Dental” offices sponsored by Wall Street private equity firms. These large chains have been the subject of numerous complaints, investigations, and even lawsuits as seen in this article and this one. Do you really want them to take care of your teeth?
- Because the fees are so low, many of these offices resort to “creative” billing practices. What does this mean? Separate charges for lab fees, local anesthesia, temporary crowns, and many more. Want proof? A treatment plan from a DMO office is located here (for privacy reasons, we had to hide any information that could identify the patient or office). This office was attempting to charge him “Porcelain Enhancement” and “Gold Enhancement” fees of $300 per crown! The end result is that the patient would have had to pay more at this office than at ours!
- Many of these offices use the cheapest labs possible. As a dentist, how do you get a cheap crown? By sending it to be made in a third world country where frequently unknown or inferior materials are used. A classic example is this news report of a crown from China being made with lead!
Please note that not all DHMO/DMO offices resort to these practices and that these observations are not specific to any particular insurance company’s DMO/DHMO plan.
In our office, we use local Connecticut labs who employ local workers and who use quality materials. We will never send our work overseas. And we will never add separate line item charges or try to “nickel and dime you.” You will always know your fee up front. That’s our promise.