Dental

How do I find out if a dental procedure, service, or device is covered by the HSHS Dental Insurance

There are several options available to you to confirm coverage.

  1. Contact Cigna’s customer service at 800-244-6224. Cigna customer service agents may be able to verify coverage.
  2. Refer to the Dental Insurance Plan summary plan description (SPD). The SPD contains detailed information about the Plan including covered services and Plan exclusions and limitations.
  3. Ask your dental provider to contact Cigna and request a pre-determination of benefits. Provider offices are often experienced with confirming coverage with insurance companies.
How is a claim for removal of impacted wisdom teeth handled?
In the event you and/or your covered dependents have both health insurance and dental insurance coverage, expenses for the extraction (removal) or excision (surgical removal) of impacted teeth are covered first under the HSHS Healthy Plan (health insurance).
  • Ask that your oral surgeon or dentist first submit claims for this service to Aetna (or Dean Health Plan if you reside in Eastern Wisconsin).
  • Once your claim for the removal of impacted teeth has been processed by Aetna (or Dean Health Plan if you reside in Eastern Wisconsin), your oral surgeon or dentist’s office should then submit any expenses not paid by the health insurance plan to Cigna for processing by the dental insurance plan.
How many dental cleanings are covered per year and how often can I go?
  • The HSHS Dental Insurance Plan provides coverage for up to two exams and up to two cleanings in a calendar year.
  • You are not required to wait six months between dental cleanings.
Is orthodontia a covered expense by the dental insurance plan and how much is covered?
The high option of the HSHS Dental Insurance Plan includes coverage for orthodontia services.

Under the high option:
  • Orthodontia services are covered at 50% after deductible with a lifetime maximum of $1,500 per covered member.
  • This lifetime maximum does not apply towards your yearly maximum benefits for all other dental services under this option.
  • Provides for a preliminary study which includes x-rays, diagnostic costs and a treatment plan.
  • The first month of active treatment and retention appliances are also covered.
What is the difference between the Basic and High dental insurance options?
Basic Dental insurance option:
  • $50 per covered person annual deductible
  • $150 annual family deductible
  • $800 yearly maximum per person on dental treatment
  • The Basic option does not cover orthodontia

High Dental insurance option:
  • $25 per covered person annual deductible
  • $75 annual family deductible
  • $1,500 yearly maximum per person on dental treatment
  • The High option also covers orthodontia with an additional $25 per covered person deductible and a separate lifetime maximum of $1,500 for orthodontia services per person.
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