2019 Benefits
Freedom to switch dental options at any time!
Options |
DMO PlanOption 1 |
PPO PlanOption 2 |
|
|---|---|---|---|
| Coverage Type |
You PayPrimary Care Dentist |
You PayIn-Network |
You PayOut-of-Network |
|
Preventive (A) Exams, X-rays, Teeth Cleanings |
$0 | $0 | 30% |
|
Intermediate (B) Fillings, Root Canals, Tooth Extractions |
$0 after copay | 25% | 40% |
|
Major (C) Implants, Crowns, Dentures, Inlays/Onlays |
$0 after copay |
50% 6-month waiting period |
|
| Orthodontics (D) | $0 after copay |
50% $3,000 maximum per person 12-month waiting period |
50% $1,500 maximum per person 12-month waiting period |
| Annual Deductible | $0 | $0 | $50 per person, $150 per family (applies to B&C services only) |
| Annual Maximum | Unlimited | $5,000 per person | $2,500 per person |
| Vision Benefits | Included with both options | ||
Option 1 - DMO
/a For economical coverage
- Choose an Aetna Primary Care DMO Dentist
- No deductible
- Free preventive care
- Braces (orthodontia) – including adults
- Implants are covered
Option 2 - PPO
/a For more freedom
- Visit any dentist without referrals
- Pay less with an Aetna PPO dentist
- Free In-Network preventive care
- Braces (orthodontia) – including adults
- Implants are covered
ENROLL TODAY – It’s Fast & Easy!
- Enroll Online; or
- Visit the Enrollment Center to download the Enrollment Forms
RATES
| BiWeekly Premium | Monthly Premium | |
|---|---|---|
| Self | $19.38 | $42.00 |
| Self + One | $38.76 | $84.00 |
| Self & Family | $58.15 | $126.00 |
Enrollment and Change Coverage Forms