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Whether you are looking for an Open Access plan with no referrals or a cost-effective plan with your Primary Care Dentist referring your care, we've got it all here at Aetna!
Aetna Dental Provider Organization (DPO): - Select Primary Care Dentist in your area from Aetna's National DMO network and obtain necessary referrals for specialist care. Find Dentists in DocFind
- Preventive and basic services covered at 100%!
- No deductibles
- Flat copayments per type of service. See your SHBP Employee Dental Plans Member Handbook for more information.
- Child and adult orthodontia coverage - See Plan booklet for lifetime maximums information
Aetna Dental Expense Plan (DEP): - Direct access to any dental provider - no referrals required - less out-of-pocket expenditure by using an Aetna Dental PPO provider - search for PPO Providers
- Preventive services covered at 100% - no deductible!
- $50 individual deductible; $150 per family (3 members at $50 each)
- $3,000 annual benefit maximum
- 80% coverage for basic services, 65% coverage for major services, 50% coverage for periodontic and prosthodontic services
- Child orthodontia coverage - covered at 50% - see Plan booklet for lifetime maximum information
- For more Information, please refer to your Dental Member Handbook.
Change to Active Employee Dental Expense Plan
- The Employee Dental Expense Plan has been changed from a passive Preferred Provider Organization (PPO) benefit design in which employees have the same coinsurance for both in-network and out-of-network providers to a true PPO. The change to a true PPO plan for Active employees increases the member share of the coinsurance when using out-of-network providers.
- The change from a passive PPO to a true PPO was made in the Retiree Dental Expense Plan effective January 1, 2010 and resulted in a 9% decrease in premiums. Since the savings has been substantial in the Retiree plan, the State Health Benefits Commission and the SHBP Plan Design Committee approved the Active Employee Dental Expense Plan also be changed from a passive PPO to a true PPO plan effective January 1, 2012.
- If your current dentist is an in-network provider, you will not see any change to your dental benefits. The new PPO plan does not change the current $50 in-network deductible or $3000 benefit maximum.
Plan Benefits Effective January 1, 2012
| Deductible/Calendar Year
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$50 / Individual
$100/Family
Waived for Preventive
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$75 / Individual
$150 / Family
Waived for Preventive
Deductible applies to in-network services as well
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| Coinsurance (as % of R & C)
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100% Preventive
80% Basic Restorative
65% Major Restorative
50% Periodontics & Prosthodontics
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90% Preventive
70% Basic Restorative
55% Major Restorative
40% Periodontics & Prosthodontics
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| Maximum Annual Benefit/Individual
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$3,000
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$2000 (Maximum of $3,000 combined in and out of network)
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| Orthodontia under age 19
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50% to $1,000 lifetime maximum (not subject to deductible)
Maximum not combined with Annual Maximum
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40% to $750 lifetime (Maximum of $1,000 combined in and out of network) not subject to deductible
Maximum not combined with Annual Maximum
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| Pre-treatment Plan Review
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Voluntary
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Voluntary
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