9 / 24
9
The Aetna dental plans allows you to visit any dentist you would like—in or out-of-network. Visiting an
in-network dentist, however, assures you that you will not be balance billed by the provider for any charges
in excess of Aetna’s negotiated fees.
To find a network provider, go to Aetna.com, then click
Menu
and select
Find A Doctor
under “Why Aetna”.
Choose the
Dental PPO/PDN w/PPO II
network and enter your search criteria.
DENTAL PLANS
Type of Plan
In-Network
Out-of-Network*
In-Network
Out-of-Network*
Deductible
Calendar Year Benefit Maximum
(Per Individual)
Preventive Services
(Oral exam, cleaning, X-rays, topical application of
fluoride, space maintainers and sealants)
Basic Services
(Fillings, endodontics, extractions, periodontic
services and oral surgery)
Major Services
(Inlay/Onlays, crowns, dentures, bridges and repair
of prior major restorative work)
Orthodontia
(children to age 19)
*Subject to Usual, Customary and Reasonable charges (90th percentile)
80% after Deductible
50% after Deductible
High PPO Plan
Covered at 50%;
$1,500 Lifetime Benefit Maximum
Low PPO Plan
Not Covered
Dental Coverage - Aetna
Individual: $50
Family: $150 maximum
$2,000
100%; Deductible Waived
80% after Deductible
50% after Deductible
Individual: $50
Family: $150 maximum
$1,000
100%; Deductible Waived