Dental (chart)

What You Pay For Services

XPO offers two dental plan options — Dental Basic and Dental Choice — and both are administered by Cigna. The table below outlines the features of each plan, which are the same in-network and out-of-network.

You can see any dentist you want. However, in-network dentists agree to accept negotiated fees from Cigna. Out-of-network dentists can bill you for amounts above the negotiated in-network fees.
2021DENTAL BASICDENTAL CHOICE
Annual Deductible
(per person)
$50$50
Preventive
(twice a year)
0% of MRC0% of MRC
Basic
(restorative)
20% of MRC after deductible20% of MRC after deductible
Major
(restorative)
50% of MRC after deductible50% of MRC after deductible
Orthodontia
(children to age 19, per person)
Not applicable50% of MRC, no deductible,
up to $1,500 lifetime benefit maximum
Annual Maximum
(per person)
$1,000$2,000

A Note About MRC: Maximum Reimbursable Charge (MRC) fees are based on the 90th percentile of the customary allowance from a fee schedule selected by Cigna.