Aetna Dental® Freedom-of-Choice Option
You can choose between two dental plans throughout the plan year. Start the year by enrolling in the Aetna Dental DMO® benefits and insurance plan. Or sign up for the Aetna Dental preferred provider organization (PPO) insurance plan.*
If your needs change, your dental plan can change, too. In fact, you can switch between the two plans every month. Just like that.
- You can change between the DMO and PPO elections throughout the year by contacting the Member Services number at (877) 238-6200 by the 15th of any month, move to new plan will be effective the 1st of the following month.
- Aetna does not mail out physical cards, gain access to the digital version of your card, or print out a physical copy of your card, by registering on the Aetna site or Aetna App.
Click on the Flyers at the bottom of page for more information.
| DMO Plan Highlights |
|---|
| Out-of-pocket costs are typically lower with this plan. |
| You need a referral to see most specialists. |
| Typically, you have no out-of-pocket costs for preventive care. |
| There are also no deductibles or yearly dollar limits. |
| PPO Plan Highlights |
|---|
| Generally, this plan has higher out-of-pocket costs than the DMO plan. |
| You can visit any licensed dentist, but you typically pay less when you stay in network. |
| No referrals are needed. |
Dental Benefits Summary
| Partial List of Services | DMO® | Active PPO | ||||
|---|---|---|---|---|---|---|
| Member Responsibility | Participating | Non-participating | ||||
| Annual Deductible** | ||||||
| Individual | None | $50 | $75 | |||
| Family | None | $150 | $225 | |||
| Preventive Services | 0% | 100% | 100% | |||
| Basic Services | 0% | 80% | 80% | |||
| Major Services | 50% | 50% | 50% | |||
| Annual Benefit Maximum | None | $2,000 | $2,000 | |||
| Office Visit Copay | $5 | N/A | N/A | |||
| Orthodontic Services (Adult and Child) | $2,000 copay | 50% | 50% | |||
| Orthodontic Deductible | None | None | None | |||
| Orthodontic Lifetime Maximum | *** | $1,000 | $1,000 | |||
| **The deductible applies to: Basic & Major services only | *** 24 months of comprehensive orthodontic treatment plus 24 months of retention | |||||
| Preventive | ||||||
| Oral examinations (a) | 0% | 100% | 100% | |||
| Cleanings (a) Adult/Child | 0% | 100% | 100% | |||
| Fluoride (a) | 0% | 100% | 100% | |||
| Sealants (permanent molars only) (a) | 0% | 100% | 100% | |||
| Bitewing Images (a) | 0% | 100% | 100% | |||
| Full mouth series Images (a) | 0% | 100% | 100% | |||
| Space Maintainers | 0% | 100% | 100% | |||
| Basic | ||||||
| Root canal therapy | ||||||
| Anterior teeth / Bicuspid teeth | 0% | 80% | 80% | |||
| Scaling and root planing (a) | 0% | 80% | 80% | |||
| Gingivectomy (a)* | 0% | 80% | 80% | |||
| Amalgam (silver) fillings | 0% | 80% | 80% | |||
| Composite fillings (anterior teeth only) | 0% | 80% | 80% | |||
| Stainless steel crowns | 0% | 80% | 80% | |||
| Incision and drainage of abscess* | 0% | 80% | 80% | |||
| Uncomplicated extractions | 0% | 80% | 80% | |||
| Surgical removal of erupted tooth* | 0% | 80% | 80% | |||
| Surgical removal of impacted tooth (soft tissue)* | 0% | 80% | 80% | |||
| Major | ||||||
| Inlays | 50% | 50% | 50% | |||
| Onlays | 50% | 50% | 50% | |||
| Crowns | 50% | 50% | 50% | |||
| Full & partial dentures | 50% | 50% | 50% | |||
| Pontics | 50% | 50% | 50% | |||
| Root canal therapy, molar teeth | 50% | 50% | 50% | |||
| Osseous surgery (a)* | 50% | 50% | 50% | |||
| Surgical removal of impacted tooth (partial bony/ full bony)* | 50% | 50% | 50% | |||
| General anesthesia/intravenous sedation* | 50% | 50% | 50% | |||
| Denture repairs | 50% | |||||
| Crown Lengthening | 50% | |||||
| Crown Build-Ups | 50% | |||||
| *Certain services may be covered under the Medical Plan. Contact Member Services for more details. | ||||||
| (a) Frequency and/or age limitations may apply to these services. These limits are described in the booklet/certificate. | ||||||
| Other Important Information: | ||||||
| This benefits summary of the Aetna Dental DMO (Dental Maintenance Organization) provides information on benefits provided when services are rendered by a participating dentist. In order for a covered person to be eligible for benefits, dental services must be provided by a primary care dentist selected from the network of participating DMO dentists. | ||||||
| Employees in AZ, CA, GA, MA, MD, MO, NC, NJ and TX must either live or work within the approved DMO® service area to be eligible to enroll in the DMO® | ||||||
| Due to state law, limited (varying by state) DMO® benefits for non-emergency services rendered by non-participating providers are available for plan contracts written in: CT, IL, KY, MA and OH and for members residing in OK (regardless of contract situs state). Attention Massachusetts residents: Before enrolling, you should be aware that our network of preferred providers in Massachusetts has providers mainly in the following counties: Barnstable, Berkshire, Bristol, Essex, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk and Worcester. Your out of pocket expenses will be higher if you do not see an in-network provider and, in some plans, benefits may not be available at all for out-of-network providers. | ||||||
| This Aetna Dental® Preferred Provider Organization (PPO) benefits summary is provided by Aetna Life Insurance Company for some of the more frequently performed dental procedures. Under the Dental Preferred Provider Organization (PPO) plan, you may choose at the time of service either a PPO participating dentist or any nonparticipating dentist. With the PPO plan, savings are possible because the participating dentists have agreed to provide care for covered services at negotiated rates. Non- participating benefits are subject to recognized charge limits. | ||||||
| Emergency Dental Care | ||||||
| If you need emergency dental care for the palliative treatment (pain relieving, stabilizing) of a dental emergency, you are covered 24 hours a day, 7 days a week. | ||||||
| When emergency services are provided by a participating PPO dentist, your co-payment/coinsurance amount will be based on a negotiated fee schedule. When emergency services are provided by a non-participating dentist, you will be responsible for the difference between the plan payment and the dentist's usual charge. Refer to your plan documents for details. Subject to state requirements. Out-of-area emergency dental care may be reviewed by our dental consultants to verify appropriateness of treatment. | ||||||
Aetna DMO Benefit Summary
Aetna PPO Benefit Summary
To Find a Network Provider
- Go to Aetna.com
- Select Find a Doctor
- Plan from an employer
- Select a Plan
- For the PPO Plan
- Search the PPO / PDN network
- For the DMO Plan
- Search the DMO / DNO network
Freedom-of-Choice Plan
Aetna Dental® DMO® plan
Aetna Dental®
DMO® Schedule
Find a Dental Provider
