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UNDERSTANDING
YOUR DENTAL PLAN
Smiles happen when Capco employees enroll in a dental plan from Aetna Dental. Capco dental benefits are provided by
Aetna. You may select either the DMO Plan, which provides in-network coverage only and utilizes a smaller network of
providers, or the PPO Plan which provides both in-network and out-of-network coverage.
TypeofPlan
DMO PLAN
PASSIVE PPO PLAN
IN-NETWORKONLY
IN-NETWORK
OUT-OF-NETWORK
Deductible
Individual
None
$50
$50
Family
None
$150
$150
Annual Maximum Benefit
None
$1,500
Preventive Services
(oral exam, cleaning, x-rays)
100%
100%
Basic Services
(fillings,rootcanal,oralsurgery)
100%
Planpays80%
after Deductible
Planpays80%
after Deductible
Major Services
(crowns, dentures, endo, periodontal)
Planpays 60%
Planpays50%
after Deductible
Planpays50%
after Deductible
Orthodontia
(Adultandchildcoverage)
$2,000 copay
$50 deductible, Planpays50% up
to$1,000 lifetime maximum
Semi-MonthlyContributions
PreTax
Post Tax
Employee
$9.10
N/A
Employee+1
$17.16
N/A
Family
$23.92
N/A
Domestic Partner (DP)*
N/A
$8.06
DP&DPChild(ren)*
N/A
$14.82
*Employees may change between dental plans at any point
during the plan year. Any change will take effect on the first day
of the month following the request for change.
The Passive PPO dental plans give you the freedom to
choose either a participating network dentist or an out-of-
network dentist. Typically you benefit from considerable cost
savings when using a dentist who is in the network.
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