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Dental Plan Options for 2016-2017
Aetna Dental Plan Options
DMO Plan
o
This plan offers In Network coverage only and includes Preventive, Basic, Major and
Orthodontia services.
Low Option PPO Plan
o
This plan offers coverage for Preventive and Basic services only.
High Option PPO Plan
o
This plan offers coverage for Preventive, Basic, and Major Services.
It is recommended you review the benefits carefully to determine which option would
best suit your dental needs.
Plan Highlights
The Dental Maintenance Organization (DMO) plan requires you designate a primary care dentist. You also
have access to in network benefits only. The DMO generally has a higher level of benefits, but a smaller
network of providers. This plan includes Orthodontia coverage.
The DMO Option plan does not have an annual maximum benefit limit.
Both the Low Option and the High Option dental plans are PPO plans (Preferred Provider Organization). They
are also both passive model PPO plans. This means the benefit percentages are the same whether you utilize
an in or out of network dentist.
Employees may receive dental care from any licensed dentist. However, you will receive a higher level of
benefits when covered services are obtained from an Aetna PPO dental provider, since these dentists have
agreed to charge a reduced, negotiated fee for their services.
The Low Option plan has a $1,000 per covered member calendar year annual benefit limit.
The High Option plan has a $1,500 per covered member calendar year annual benefit limit.
Balance billing can occur when a non-participating provider charges over and above Aetna’s Usual &
Customary Rate (UCR) for a service. When this happens, the provider can charge the member the difference
between their fee and Aetna’s payment.
Children are covered to age 26 regardless of student status on all dental plan options.