What does the Aetna Dental PPO Plan cover?
Basic plan summary: • Annual Benefit Maximum $3,000 in-network/$2,000 out of network per member (includes Basic, Intermediate and Major services). • Visit any licensed dentist, anywhere without a referral. • No Deductible • Preventive/Basic Services 100% covered* e.g. Cleanings, X-rays, Sealants, Space Maintainer and Fluoride • Intermediate Services 60% covered* e.g. Fillings, Theraputic Pulpotomy, Uncomplicated Extractions, Periodontal Scaling, Denture Adjustment and Repair • Major Services 40% covered* e.g. Inlays, Onlays, Crowns, Root Canal, Full & Partial Dentures, Pontics, General Anesthesia/Intravenous Sedation • Orthodontic Services** 30% covered* • Orthodontic Lifetime Maximum $1,500/member *Aetna will pay the percentages listed above as follows: In network – percentage of our negotiated fee with the participating provider. Member not responsible for amounts above the negotiated fee. Out of network – percentage of the provider’s prevailing charge (usual & customary – 75th perce
Basic plan summary: • Annual Benefit Maximum $3,000 in-network/$2,000 out of network per member (includes Basic, Intermediate and Major services). • Visit any licensed dentist, anywhere without a referral. • No Deductible • Preventive/Basic Services 100% covered* e.g. Cleanings, X-rays, Sealants, Space Maintainer and Fluoride • Intermediate Services 60% covered* e.g. Fillings, Theraputic Pulpotomy, Uncomplicated Extractions, Periodontal Scaling, Denture Adjustment and Repair • Major Services 40% covered* e.g. Inlays, Onlays, Crowns, Root Canal, Full & Partial Dentures, Pontics, General Anesthesia/Intravenous Sedation • Orthodontic Services** 30% covered* • Orthodontic Lifetime Maximum $1,500/member *Aetna will pay the percentages listed above as follows: In network – percentage of our negotiated fee with the participating provider. Member not responsible for amounts above the negotiated fee. Out of network – percentage of the provider’s prevailing charge (usual & customary – 75th perce
