Page 14 - IPsoft 2018 Benefits Guide

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IPsoft, Inc. offers a DPPO (Dental Preferred Provider Organization) through Aetna. You may choose to receive services from any dentist of your choice. When you use an in-network provider, the in-network dentist will submit claims to Aetna directly and then Aetna will bill you for the amount you are required to pay under the plan. The cost of coverage is less for in-network providers due to negotiated contract fees. If you use an out-of-network dentist, you will need to le a claim for reimbursement and may be billed by the dentist for the amount changed that exceeds the allowed amount. No referrals are needed for specialty care.
AETNA DENTAL PPO
BENEFIT HIGHLIGHTS
Annual Deductible
Preventive Dental Services
Major Dental Services
Orthodontia Lifetime Maximum
$50 Individual / $150 Family
100%
50%
Not Covered
$50 Individual / $150 Family
100%
50%
Not Covered
In-Network
Out-of-Network
Calendar Year Maximum Bene t
$2,500
$2,500
Of ce Visit Copay
N/A
N/A
Basic Dental Services
80%
80%
Orthodontia Services (Dependent children under age 19)
Not Covered
Not Covered
*Deductible applies to Basic and Major services only.
2018 Benefits