Summary of Benefits Cap Blue Small Group Dental Ppo Plus
Explore dental plan choices
Aetna Dental offers one of the largest PPO and DMO networks in the industry with significant discounts for our members. Check out these affordable plan options.
Dental Maintenance Organization (DMO) plan
Guidance and great savings
With Aetna Dental DMO*, you get quality dental coverage that fits everyone's budget. An in-network primary care dentist (PCD) guides members' care. There's no paperwork or hassles.
Plan features:
- In-network PCD required
- Lower premiums
- Referrals required for specialty care (except orthodontia)
- No deductibles, claims or annual maximums
- No lifetime limit for major services
Preferred Provider Organization (PPO) plan
Freedom to always choose
If your members like freedom, they'll love Aetna Dental PPO. They can visit any in-network dentist to keep rates lower or choose to see any dentist. There are no referrals required either way.
Plan features:
- Freedom to see any licensed provider
- Lower costs for staying in network
- No PCD or referrals required
- Higher premiums than DMO
- Deductibles and yearly limits apply
Indemnity plan
Any licensed dentist, anywhere
With Aetna Dental Indemnity, there's no need to choose a PCD. Members can visit any licensed dentist in the country and pay their bill on the spot. To get reimbursed, they may need to file a claim.
Plan features:
- Freedom to visit any licensed dentist
- Cost share paid directly to the dentist
- No referrals required
- Great for fully insured and self-funded customers
- Annual and lifetime coverage limits may apply
Freedom of Choice plan
Flexibility for changing needs
With Aetna Freedom-of-Choice, members can switch between two plans — with two networks — to fit their needs. They can choose our DMO for the simplicity and savings of in-network, PCD-guided care. Or choose our PPO or indemnity plan to visit any provider.
Plan features:
- Flexibility to switch plans throughout the year, as often as every month
- One convenient price
- Freedom to visit providers in or out of network
- No PCD or referrals required (PPO & Indemnity)
*For DMO plans, some states allow limited benefits when members go out of network for covered services. In Illinois, DMO plans provide limited out-of-network benefits, but to receive maximum benefits, members must select and have care coordinated by a participating PCD. In Illinois, the DMO plan is not a health maintenance organization (HMO). In Virginia, the DMO plan is known as the Dental Network Only plan (DNO). DNO in Virginia is not an HMO. In California, dentists may refer members to out-of-network dentists for some services.
Bringing value to your dental plan
Mobile dentistry
We're bringing the dentist to employees with a mobile or in-office clinic.
- There's no cost to you.
- Services may include preventive care such as cleanings, X-rays, exams and restorative procedures such as fillings and crowns.
- Services vary by provider.
Alternative orthodontics
We're partnering with online vendors to offer convenient, certified orthodontic solutions.
- Providers oversee remote treatment and guidance from beginning to end.
- There's no need for in-person appointments.
- Supplies are delivered directly to home from Candid® or SmileDirectClub®.
Teledentistry
We're working with network providers to offer teledentistry services to give members more choice and convenience.
- Members can connect with dentists through virtual visits using technology such as Facetime or Skype.
- Dental providers can offer routine and/or oral evaluations, answer questions, give advice, prescribe medicine and refer patients to specialists, if needed.
- Teledentistry helps avoid unnecessary travel and costs, emergency room visits or time away from work or school.
Member tools and resources
Taking charge of health and benefits is easier with the Aetna member website.
After logging in, your members can:
- Pull up their ID card
- Search for network dentists by name, specialty or procedure
- View dental plan summary and what's covered
- Track spending and progress toward meeting deductible
- View and pay claims
- Get cost estimates before receiving care*
- Access discounts on additional services and products
*This service is available only for dental members on a PPO plan.
Pairing dental and medical for powerful health
*Ongoing, statistically valid analysis of Aetna Dental/Medical Integration program customers.
*Choose a toothpaste that contains fluoride and an antibacterial ingredient. Also make sure the toothpaste carries the American Dental Association Seal of Acceptance.
Source: https://www.aetna.com/health-insurance-plans/dental.html
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