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P A G E 8
Dental Benefits
A comprehensive dental plan is offered through Aetna. Please note that you can
save more money and you receive a greater benefit when you visit a dentist in the
provider network. To find a dental provider, go to
www.aetna.com/docfindor call
the Member Services number on your ID card. When searching online, elect
Dental PPO/PDN with PPO III
Network
.
Aetna Plan P7302
Network: National Option PPO 20
Benefit
Aetna PPO
In-Network
Out-of-Network
Annual Deductible (Calendar Year)
Individual
Family
$50.00
$150.00
Annual Benefit Maximum (Calendar Year)
Applies to Class I - III
$2,000
$2,000
Class I - Diagnostic & Preventive Services
100%
100%
Class II - Basic Dental Services
90%
80%
Class III - Major Dental Services
60%
50%
Class III - Implants
60%
60%
Class IV - Orthodontic Services
50% (adult & child)
50% (adult & child)
Orthodontia Lifetime Maximum
$1,000
$1,000
Employee Payroll Deductions (per pay)
Employee Only
$0.00
Employee/Spouse
$10.00
Employee/Child
$9.00
Employee/Children
$9.00
Enrollment Tier
Payroll Deduction
Family
$15.00