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BENEFITS
Dental Insurance
Aetna | PPO Dental Plan
With the Aetna Dental Preferred Provider Organization (PPO) dental plan, you may visit a PPO dentist and benefit from the
negotiated rate or visit a non‐network dentist. When you utilize a PPO/PDN dentist, your out-of-pocket expenses will be less. You
may also obtain services using a non-network dentist; however, you will be responsible for the difference between the covered
amount and the actual charges and you may be responsible for filing claims.
Aetna PPO
Plan Name
Network Name Dental PPO/PDN w/PPOII Network Out of Network (80th % UCR)
Dental Benefits Member Pays
Calendar Year Maximum $1,500 $1,500
Deductible (Annual)
- Individual $50 $50
- Family $150 $150
Preventive No Charge No Charge
Exams, X-Rays, Cleanings (Deductible waived) (Deductible waived)
Basic Services Deductible, 20% Deductible, 20%
Fillings, Oral Surgery, Endodontics, Periodontics
Major Services Deductible, 50% Deductible, 50%
Crowns, Dentures, and Bridges
Orthodontia
- Covered Members Adult & Child Adult & Child
- Coinsurance 50% 50%
- Lifetime Benefit Maximum $1,000 $1,000
Finding a Dental Provider
Go to www.aetna.com. Enter your zip code or city/state and click search. When asked to select a plan choice,
refer to the “Dental PPO/PDN with PPOII” network when prompted.
Tips For Using Your Dental Benefits
Use contracted network providers when possible.
If you choose to see a dentist outside of the network, you’ll be reimbursed based on Usual and Customary (UCR) charges at
the 80th percentile. You would be responsible for any amounts over the UCR as well as any coinsurance.
Ask for a predetermination of benefits.
We strongly recommend you ask your dentist for a predetermination if total charges are expected to exceed $300.
Predetermination enables you and your dentist to know in advance what the payment will be for any service that may be in
question.
Have dental checkups regularly.
Routine dental visits not only preserve your smile, but they can provide an opportunity for the early detection of serious
diseases such as diabetes.
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