Page 17 - Parsons and Parsons Corp ODD EE Guide 1 1 17_FINAL 11.1.16

Benefits For Your Health

DENTAL INSURANCE
Aetna Freedom of Choice allows you to choose between a Traditional Plan Option, which includes an in-network Preferred Provider
Dental Option (PDO), or a DMO In-Network Option.

With the Freedom of Choice feature, you or covered family members may switch between the In-network DMO and the DPO by
logging into bswift before the 15th of any month. The change will be effective on the first of the following month. You can change
your Personal DMO Dentist by calling Aetna at (877) 238-6200.

Option 1
Aetna | DMO Dental Plan
With the Dental Maintenance Organization (DMO) plan through Aetna, you are required to select a general dentist who is a
member of the DMO network to provide your dental care. You will contact your general dentist for all of your dental needs, such as
routine check-ups and emergency situations. If specialty care is needed, your general dentist will provide the necessary referral. For
covered procedures, you'll pay the pre-set copay or coinsurance fee described in your DMO plan booklet. Please keep a copy of
your booklet to refer to when utilizing your dental care. This will show the applicable copays that apply to all of the dental services
that are covered under this plan.
Option 2
Aetna | PPO Dental Plan
With the Aetna 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 DPPO II 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.
Option 1 Option 2
Plan Name Aetna—DMO Aetna—PPOII
Network DMO Network Non-Network
Dental Benefits

Calendar Year Maximum Unlimited $2,000 $1,000
Deductible (Annual)
- Individual $0 $50 $50
- Family $0 $150 $150

Preventive (Plan Pays) Covered 100% Covered 100% Covered 100%
Exams, X-Rays, Cleanings
Basic Services (Plan Pays) Covered 100% 80% after deductible 80% after deductible
Fillings, Oral Surgery, Space Maintainers
Endodontics, Periodontics
Major Services (Plan Pays) 60% after deductible 50% after Deductible 50% after deductible
Inlays, Onlays, Crowns, Prosthetics

Orthodontia
- Covered Family Members Children to Age 19 Not Covered
- Coinsurance 50% Not Covered

Finding a Dental Provider
Go to www.aetna.com or call (877) 238-6200. Refer to the DMO or DPPO II network when prompted.

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.
17