(State and higher education employees | retirees if receiving a monthly pension from the Tennessee Consolidated Retirement System based on their own service or if they participated in a higher education optional retirement plan | local education and local government employees if employing agency offers the state group dental insurance plan)
Eligible employees and retirees can choose from two different dental insurance plans. Members pay the full monthly premium. We recommend comparing the networks and benefits.
All newly enrolled members will receive new ID cards. Members can request additional ID cards by contacting their insurance company or by using the insurance company's mobile app.
Delta Dental of Tennessee Dental Preferred Provider Organization
Members can use any dentist, but will save money when using an in-network provider. Members pay deductibles and co-insurance for services.
7 a.m. to 5 p.m. CT
Delta Dental DPPO – DeltaDentalTN.com/StateofTN
More about the Delta Dental DPPO
· You can use any dentist, but you’ll save money and receive maximum benefits when visiting an in-network DPPO provider for the state's dental plan.
· You pay deductibles and co-insurance for some dental care. Deductible does not apply to diagnostic and preventive benefits such as periodic oral evaluation.
· You or your dentist will file claims for covered services. Discuss any estimated expenses with your dentist or specialist. Your dentist and you may want to request a pre-treatment cost estimate from Delta Dental for some procedures. Charges for dental procedures are subject to change.
· There is a six‐month waiting period from the member’s coverage start date that applies to inlay/onlay, restorations, dentures, crowns and implants. However, there is a 12-month waiting period from the member’s coverage start date that applies to initial placement of bridge or dentures to replace one or more natural teeth if the tooth or teeth were missing prior to member's effective date of coverage and for orthodontic treatment.
· Teledentistry is offered and claims are handled as if the patient received dental services in a dental office. Charges are considered as Type A: Diagnostic and Preventive and are subject to frequency limitations.
· Referrals to specialists are not required.
· Dental treatment in progress at time of member’s effective date with Delta Dental may have pro-rated benefits under the Delta Dental plan. Delta Dental will work with your dentist to ensure you continue to receive the benefits that are covered. For orthodontic claims, ask your orthodontist or dental office to submit a claim with the total fee, initial banding date and total number of months of treatment. This detail will allow Delta Dental to calculate what may be paid.
· See the Certificate of Coverage for coverage details.
· You pay coinsurance for many covered services and your share is based on the provider negotiated fee, or PNF agreed upon by the provider and Delta Dental of Tennessee. The PNF, also called the Maximum Plan Allowance, is the highest dollar amount of reimbursement for specific dental procedures provided by Delta Dental DPPO in-network providers. The in-network dentists have agreed not to charge members or the plan more than the PNF. When a member receives dental services from an out-of-network provider, the out-of-network dentist will be paid by the plan for covered procedures according to the average PNF for in-network providers and respective plan coinsurance. The member then is responsible for all other charges by the out-of-network dentist.
· To learn about all DPPO benefits, find the Delta Dental DPPO handbook under Publications and Dental PPO.
Cigna Dental Health Maintenance Organization - Prepaid Provider
Members are required to use a network general dentist. Members must select a network general dentist and notify Cigna. Members pay copays for services. Members may want to request a pre-treatment estimate to understand the costs prior to receiving service. Review the Patient Charge Schedule under Publications and Dental HMO - Prepaid Provider.
Provider search on Cigna Splash Page
The search at the Cigna splash page shows all of the dentists in the network for the state of Tennessee and requires a user log in, which is provided in the instructions below.
Cigna DHMO — Cigna's splash page
Provider search on Cigna’s website
The search at Cigna’s website shows only the general dentists in the network for the state of Tennessee, but does not require a user log in. Dentists not included on this search can be found on the Cigna DHMO – SOT Specific Provider List. Instructions on how to use this search are located below.
Cigna DHMO — Cigna's website
More about the Cigna DHMO
· You must select and use a Cigna network general dentist from the DHMO list for the state’s dental plan and let Cigna know of your choice.
· You must use your selected dentist to receive benefits.
· You may select a network pediatric dentist as the network general dentist for your dependent child under age 13. The pediatric dentist will be considered a “specialist” for plan benefits. At age 13, you must switch the child to a network general dentist or pay the full charge from the pediatric dentist.
· There may be some areas in the state where network general dentists are limited or not available. Before enrolling, carefully check the network for your location.
· With the DHMO, you may be able to cancel this coverage if you enroll and later there are no network general dentists within a 25-mile radius of your home address.
· You pay copays for dental treatments. Review the Patient Charge Schedule under Publications and Dental HMO - Prepaid Provider at https://www.tn.gov/partnersforhealth/publications/publications.html before having procedures performed. Lab fees may apply for some procedures and are the responsibility of the member to pay.
· No deductibles to meet, no claims to file, no waiting periods, no annual dollar maximum.
· Preexisting conditions are covered.
· Referrals to specialists by network general dentists are required.
· Teledentristy offered at no charge.
· The completion of crowns, bridges, dentures, implants or root canals already in progress on a new member’s effective date will not be covered. For orthodontic services in progress, new members may be eligible to receive a monthly contribution based on the number of months left in treatment. Please review the Cigna DHMO Ortho in Progress Payment Schedule posted under Publications > Dental HMO Prepaid Provider.
· See the Certificate of Coverage under Publications and Dental HMO - Prepaid Provider at https://www.tn.gov/partnersforhealth/publications/publications.html for complete details.
· To learn about all DHMO benefits, find the Cigna DHMO handbook by clicking on Publications and Dental HMO – Prepaid Provider.
Additional enrollment information
Continuation of dental coverage through COBRA or the retiree dental plan
If you are enrolled in dental coverage as an ACTIVE employee under a state sponsored plan and your employment is terminated (separation of service or retirement), you will be given the opportunity to continue your dental coverage for 18 months under the Consolidated Omnibus Budget Reconciliation Act , or COBRA. A COBRA notification will be mailed to your home address listed in Edison upon the termination of your active coverage. To continue dental through COBRA, you must complete and return the COBRA enrollment form to Benefits Administration within 60 days of the latter of the date active coverage would end or the date on the COBRA notification letter. Please indicate if you are a Tennessee Consolidated Retirement System, or TCRS retiree via a hand written note on the signature page of the COBRA enrollment form. Continuation of dental insurance is NOT automatic at retirement.
If you do not qualify to continue dental insurance through COBRA or simply wish to enroll in the retiree dental plan upon the termination of your active insurance coverage, you should submit an application directly to Benefits Administration. Please note, you must be a TCRS retiree or an optional retirement plan, or ORP retiree from a higher education agency.
Upon expiration of your COBRA coverage, if you enrolled in this option and you are receiving a monthly TCRS pension or a higher education ORP retiree, you will be given an opportunity to enroll in the retiree dental plan.
NOTE: A complete description of the benefits, provisions, conditions, limitations and exclusions for both the Delta Dental and Cigna dental plans will be included in their respective Certificate of Insurance. If any discrepancies exist between the information listed above and the legal plan documents, the legal plan documents will govern. We recommend you review these documents.