The Aetna Dental PPO Plans

Dental Member Education Tools
Dental Health Information
Your Covered Dental Services
What's Not Covered

Dental Benefits to Keep You Smiling

The dental benefits plan can help by putting easy-to-use dental benefits and a wealth of resources at your fingertips...to help keep your teeth -- and your overall health -- the best that they can be!

Research shows that more than 90 percent of all systemic diseases – those diseases that impact the entire body – are detectable in the mouth¹.

Oral tissues not only reflect symptoms of other problems, but infections in these tissues can also have consequences throughout the body. So your dentist can plan a critical role in helping to identify potential health risks.

Looking at the whole picture

If you have both an Aetna medical and dental plan, we can put our knowledge to work for you because we have a complete picture of your claims history.

Members who are in our care management programs, which support chronic diseases such as diabetes or heart disease, or who are expectant mothers, can receive educational materials highlighting the importance of oral health as it relates to their specific health concern.

This collaborative approach allows us to promote the prevention, early detection and treatment of health problems and disease.

Visit the Licensed Dentist of Your Choice

You have the freedom to visit any licensed dentist for your covered dental expenses. However, your out of pocket costs will generally be lower when you use network providers because they bill at lower, negotiated rates.

Simply pay your dentist for the service performed. Then, either you or your dentist can submit a claim form for reimbursement. Reimbursement will be based upon the reasonable and customary fee for service in that area.

You are required to meet an annual deductible ($25 individual; $50 family) for all covered services before your plan will begin to pay for covered services. Note that the deductible is waived for preventive care services.

Once your deductible is met, you pay a coinsurance amount (a percentage of covered expenses). Refer to your dental benefits summary within Your Guide to Enrollment to determine the coinsurance percentage you must pay.

Services are generally subject to deductibles, coinsurance and annual and lifetime benefits maximums.

You do not have to get a referral or show an ID card before seeking care.

If you are considering enrolling in one of Aetna's Dental PPO plans, you can find additional information here regarding your ongoing dental or orthodontic treatment. Also, check out this video that reviews common questions and answers on the Aetna Dental PPO.

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Dental PPO Member Education Tools

There is more than one way to achieve a healthy smile! Your plan also gives you the tools you need to manage your Dental PPO benefits and access the dental health information that matters most to you — online, or by calling the toll-free number on the your Dental PPO ID card. Resources include:

Member Services

Aetna's dedicated team of trained service professionals is ready to assist you if you have questions regarding your coverage or a claim, or if you need help finding a dentist. Go to www.aetna.com and click on "Member Service Login", or call the toll-free Member Services number located on your ID card.

Aetna Navigator^® Self-Service Member Website

When you log on to www.aetna.com and select our easy-to-use Aetna Navigator member website, you can perform a variety of self-service transactions online — 24 hours a day, 7 days a week — wherever you have Internet access. When you register for Aetna Navigator, you can:

• Review who is covered by your dental plan.
• Check the status of your dental claim.
• Access Explanation of Benefits (EOB) statements.
• Receive an e-mail when your EOB statement is available for you to view on your secure home page.
• View and print instant eligibility information.
• Send e-mail inquiries to Member Services.

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Dental Health Information Website

This online dental health resource, available through the Aetna InteliHealth^® website, can help you become a better informed health care consumer. You'll find information on dozens of dental conditions and treatments, illustrations, interactive tools, answers to common questions, and articles in several dental specialty areas all online.

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Your Covered Dental Services

Your Dental PPO plan offers you coverage for a broad range of dental services, including:

• Preventive care (cleanings, bitewing and full-mouth X-rays, and more)
• Restorative care (fillings and basic restorative work; bridges, crowns, dentures and more)
• Orthodontia and Periodontal services (Coverage is only available if you are enrolled in the High Option Dental PPO Plan.)

In addition, specialty and emergency care are covered within the categories above. Please see your dental benefits summary within Your Guide to Enrollment for details on benefit levels, covered services, plan provisions, exclusions and limitations.

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What's Not Covered

Below is a partial list of the charges and services this dental plan does not cover. For a complete list of exclusions and limitations, refer to your plan documents.

• Dental services or supplies that are primarily used to alter, improve or enhance appearance.
• Experimental services, supplies or procedures.
• Treatment of any jaw joint disorder, such as temporomandibular joint disorder.*
• Replacement of lost, missing or stolen appliances and certain damaged appliances.
• Those services that Aetna denies as not necessary for the diagnosis, care or treatment of a condition involved.
• All other limitations and exclusions in your plan documents

*Other exclusions apply.

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