Page 7 - AB Mauri 2022 Benefits Guide OHLY
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2022 Benefits Enrollment
Dental Plan
We partner with Aetna to ofer you and your family members dental insurance. When using an in-network
dentist, your out-of-pocket costs are lower and your plan covers a larger share of the charges. If you choose
to use a dentist who does not participate in the Aetna network, you may be subject to being balance billed
by the provider. Dental insurance is provided at no cost to you.
In-Network Out-of-Network
Individual: $25 Individual: $25
Calendar Year Deductible
Family: $75 Family: $75
Annual Maximum Beneit Amount $1,500
Preventative Services— Exams, Cleanings, X-Rays, Covered at 100%; no deductible
Fluoride, Sealants, Space Maintainers
Basic Services—Fillings, Emergency Exams,
Simple Extractions, Periodontics, Endodontics, Covered at 80% after deductible
Oral Surgery
Major Services—Crowns, Inlays, Onlays, Bridges, Covered at 50% after deductible
Dentures
Covered at 50% no deductible
Orthodontia—Adults and Children up to age 26
$2,000 lifetime beneit
Find a Dental Provider
Visit www.aetna.com/individuals-families/ind-a-doctor.html
Under “Guests,” click on “Plan from an Employer”
Enter your home location and the miles range you wish to search
Scroll down and select the “Dental PPO/PDN with PPO II and Extend” network and click “Continue”
Scroll down and click on “Dental Care” then search by dentists, dental specialists, pediatric dentists, orthodontists, etc.
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Dental Plan
We partner with Aetna to ofer you and your family members dental insurance. When using an in-network
dentist, your out-of-pocket costs are lower and your plan covers a larger share of the charges. If you choose
to use a dentist who does not participate in the Aetna network, you may be subject to being balance billed
by the provider. Dental insurance is provided at no cost to you.
In-Network Out-of-Network
Individual: $25 Individual: $25
Calendar Year Deductible
Family: $75 Family: $75
Annual Maximum Beneit Amount $1,500
Preventative Services— Exams, Cleanings, X-Rays, Covered at 100%; no deductible
Fluoride, Sealants, Space Maintainers
Basic Services—Fillings, Emergency Exams,
Simple Extractions, Periodontics, Endodontics, Covered at 80% after deductible
Oral Surgery
Major Services—Crowns, Inlays, Onlays, Bridges, Covered at 50% after deductible
Dentures
Covered at 50% no deductible
Orthodontia—Adults and Children up to age 26
$2,000 lifetime beneit
Find a Dental Provider
Visit www.aetna.com/individuals-families/ind-a-doctor.html
Under “Guests,” click on “Plan from an Employer”
Enter your home location and the miles range you wish to search
Scroll down and select the “Dental PPO/PDN with PPO II and Extend” network and click “Continue”
Scroll down and click on “Dental Care” then search by dentists, dental specialists, pediatric dentists, orthodontists, etc.
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