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City of O’Fallon
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DENTAL INSURANCE
Our dental plan is provided by Aetna. You will
have coverage both in network and out of
network. It is to your advantage to utilize a
network dentist to take advantage of contracted
fees. You will experience the deepest discounts
when seeing an in network dentist. If you go out
of network, you will be responsible for any
amount exceeding Aetna’s negotiated rates plus
any deductible and co-insurance associated with
your procedure.
To find a participating dentist in your elected
plan, visit
www.aetna.com.
Aetna Dental
Benefit/Service (Base Plan)
In Network
Out of Network
Benefit
Preventive
100%
100%
Basic
90%
80%
Major
60%
50%
Ortho
50%
50%
Deductibles & Maximums
Deductible Individual **
$25
$75
Deductible Family
$75
$225
Annual Maximum Per Person
$2,000
** Does not apply to preventive services
Lifetime Orthodontia Maximum
( child only up to age 19)
$2,000
Endodontics
80%
80%
Periodontics
80%
80%
2016 Employee Dental Contributions
Employee Deduction
Per Month
Per Pay
Period
Employee
$6.00
$3.00
Employee & Family
$34.00
$17.00