The employee pays the remainder through payroll deduction Premiums are deducted on a pre-tax basis Contact Information at Aetna Customer Service 1-877-238-6200 or www.aetna.com About the Plan Aetna Dental Summary - Effective January 1, 2023 Aetna Dental PPO For which you have no legal obligation to pay. 2022 . Crown, inlays and onlays, and veneers unless for one of the following: All services deemed "never effective" are excluded from coverage. Provided for your personal comfort or convenience, or the convenience of any other person, including a dental provider. Claims must be submitted within 365 days of the date you received the service. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". PLAN EXCLUSIONS AND LIMITATIONS* Dental implants, false teeth, prosthetic restoration of dental implants, plates, dentures, braces, mouth guards, and other devices to protect, replace or reposition teeth and removal of implants Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Preventive services Waiting period*: None, Basic services are covered at 80% with in-network providers (after deductible), Major services are covered at 50% with in-network providers (after deductible), Waiting periods for basic and major care waived with prior dental insurance, No waiting periods for preventive services, See any dentist, but youll save more if you stay in network, 100% coverage for preventive services when you see an in-network dentist, Basic services covered at 80% with in-network providers (after deductible), Major services covered at 50% with in-network providers (after deductible), Waiting periods* for Basic and Major services waived with prior dental insurance, $50 individual / $150 family per calendar year, Waiting period is waived if all family members enrolling had dental coverage within the past 90 days. In MD and NJ, student medical insurance is underwritten by Aetna Health and Life Insurance Company (AHLIC).Self-insured plans are funded by the applicable school, with claims administration services provided by Aetna Life Insurance Company. And you dont have to have Aetna medical or other coverage with us to purchase. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. You can choose from one of the more than 420,000 dentist locations in the Aetna Dental PPO network. To check that your provider participates, visit our website or call us. Check your plan's Evidence of Coverage. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. You may be balance billed by out-of-network dentists up to the dentists standard fee. When you have an Aetna Dental plan, you know youre taking the right steps toward being healthy. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). When billing, you must use the most appropriate code as of the effective date of the submission. All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. Dental plans are all different. That would not be made if you did not have coverage. the difference in cost between the approved less costly service and the more costly covered service. Section 5 Dental Services and Supplies Class A Basic 16 . PDF Summary of Benefits and Coverage: What this Plan Covers - Aetna Feds Visit any licensed dentist outside the network. And one of the main perks of joiningaMedicare Advantage (MA)planis that many plans offer dental coverage to helpyoukeep upwithyour oral health. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. **Out-of-network benefits vary by state and are subject to certain charge limits. No deductible, no claims forms and no yearly dollar limits. You can find a network provider by logging in as a member and going to our provider directory. That are experimental or investigational. Network dentists also file claims for you. You may pay more when you get care from dentists who arent in the network.**. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. The plan offers preventive treatment at 100% with no out of pocket cost. Top 3 reasons to choose Aetna Dental Please log in to your secure account to get what you need. Due to therelatively high out-of-pocket costs for these procedures, some older adultsend up forgoing necessary dental care. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Your Payer Express log in may be different from your Aetna secure member site log in. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Aetna Dental Insurance Plans for Seniors in 2023 - The Senior List Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Legal notices Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). This Agreement will terminate upon notice if you violate its terms. 5 Visit AetnaMedicare.com to learn more about the 2022 Aetna Medicare plans. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts. Please log in to your secure account to get what you need. Aetna Vital Savings provides participants with access to a network of independent practicing providers. Others have four tiers, three tiers or two tiers. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. Get the coverage you need to keep your mouth, teeth and gums healthy. Do you cover implants? This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. Consent is not required to download the app. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Voluntary Dental and Vision Plans | Columbia Health Privacy policy: Aetna.com/legal-notices/privacy.html. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. The ABA Medical Necessity Guidedoes not constitute medical advice. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Is there a maximum dental benefit? Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Annual Deductible $50 Per Person $150 Per Family, per calendar year, Annual Maximum Benefit $1,250 per covered person. Does Aetna Medicare Cover Dental? 2022-2023 Coverage Explained With our dental insurance plans for individuals, you can get services from either a participating or nonparticipating dentist. This site has its own log in. Visit the secure website, available through www.aetna.com, for more information. Blue Cross Blue Shield FEP DentalSM The replacement of; addition to; or modification of: existing dentures; crowns; casts or processed restorations; removable denture; fixed bridgework; or other prosthetic services is covered only if specific criteria are met. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. That are provided by a family member. With Aetna Dental Direct, you'll get the coverage you need to keep your teeth healthy. This search will use the five-tier subtype. Since there is no paperwork or reimbursement, you must pay for the service at the time its provided. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Aetna handles premium payments throughInstaMed, a trusted payment service. your primary care dentist will refer you to one in our network. Deductible: the dollar amount some plans require you to pay for services before coverage starts. Aetna Dental Coverage | New York State Nurses Association The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. You can also submit paper claims. Pricing starts at $20 in most regions, and also includes: No waiting periods Inclusive plans. These typically include some level of dental coverage, including twice-yearly oral health exams, teeth. Some subtypes have five tiers of coverage. The program does not make any payments to providers. Language services can be provided by calling the number on your member ID card. If you do not intend to leave our site, close this message. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. It may be different from your Aetna secure member site log in. Check with your plan for more details. Sign up at BeneFeds.com or call 1-877-888-3337. ** Out-of-network benefits are paid based on recognized charge levels, as determined by Aetna and specified in your plan documents. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Temporomandibular joint dysfunction/disorder. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Dental care is a vital part of maintaining yourhealth and well-being, especially as you age. 2022 A Nationwide Dental PPO Plan IMPORTANT Rates: Back Cover Changes for 2022: Page 4 . This is donethrough an optional supplemental benefit. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Treating providers are solely responsible for dental advice and treatment of members. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Links to various non-Aetna sites are provided for your convenience only. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. ***Certain brands impose a no-discount policy. PDF A Nationwide Dental PPO Plan - Aetna Feds The SBC shows you how you and the plan would share the cost for covered health care services. How to enroll: Language services can be provided by calling the number on your member ID card. Aetna Inc. and itsaffiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. If you do not intend to leave the Medicare site, close this message. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. By texting 90156, you consent to receive a one-time marketing automated text message from Aetna with a link to download the Aetna Health app. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna MAplans offer three types of dental benefits:network,direct memberreimbursementallowanceand optional supplemental benefits. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. If you do not intend to leave our site, close this message. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Print and fill out the reimbursement form. your coverage will begin on January 1, 2022. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Do you cover adult orthodontia? Aetna Inc. and itsaffiliated companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. Aetna Dental has over 60 years of experience offering dental benefits. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Find your dentist now in Aetna's large nationwide network. Dental information programs provide general dental information and are not a substitute for diagnosis or treatment by a dentist or other health care professional. Out of network: You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. There is one exception, however:If you needmedicaldental procedures whileyourein the hospital, Medicare may pay for those services as part of Medicare Part A (hospital insurance). It gives members access to discounted fees according to schedules negotiated with providers by Aetna Life Insurance Company for Aetna Vital Savings. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Provided by an out-of-network provider in excess of the recognized charge. The Aetna Vital Savings discount program is not insurance. Each main plan type has more than one subtype. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. Visit a dentist in the Aetna Dental PPO* network. 1According to the Aetna Enterprise Provider Database as of May 1, 2018. The member's benefit plan determines coverage. You may pay more when you get care from dentists who arent in the network.**. For additional language assistance: Choose from more than 120,000 dental providers nationwide, including providers who offer virtual visits through tele-dentistry. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Aetna Dental plans come with special perks and discounts, including exclusive offers from CVS Health. Links to various non-Aetna sites are provided for your convenience only. 2022 Aetna Dental 2 Enroll at www.BENEFEDS.com . Please call them at the number on your member ID Card or at 877-480-4161 from 8:30 a.m.-5:30 p.m, Mon-Fri. Or it may be coinsurance, which is a percentage of the dentists charge. Get coverage to any doctor (in or out-of-network) at the same member cost share. Coinsurance: the percentage of dental care expenses you pay after your deductible. There also may be age and frequency limits on some services. For prescribed drugs, pre-treatments or analgesia. Aetna Medicare SM Plan (PPO) Learn more about Aetna Feeling Good: Your Verizon Aetna magazine Check out Feeling good , the magazine created specifically for Verizon Aetna members. For PPO plans and most HMO-POS plans, you have the option to go to any licensed provider, but could save money by using a provider in the network. As you age, maintaining your oral health is an important part of your whole-body wellness. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". *Actual costs and savings vary by provider and geographic area. offering the same type of coverage; i.e., you (or covered family members) cannot be covered by two FEDVIP dental plans or two FEDVIP vision plans. No claims or paperwork for in-network care. Note not all Aetna dental plans and offers available in all markets.