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The Core and Premium Dental are preferred provider organization (PPO) dental plans. They cover the services of any qualified provider, but pay more for certain services when you use an Aetna PPO dentist. An Aetna PPO dentist also will automatically handle claims for you as well as any required predetermination of benefits. If you use a non-PPO dentist, your share of the cost of services is higher and you may also be responsible for charges that are above reasonable and customary for that service. You will also need to make sure the dentist submits claims to Aetna for you and obtains predetermination of benefits.

The Core and Premium Dental plans both cover the same types of dental services. Both plans require you to meet a deductible, then pay a percentage of covered expenses. The main differences between the two plans are the amounts of the calendar year maximum benefit and orthodontic lifetime maximum benefit. The Summary of Benefits chart shows these maximums, as well as deductibles and benefit levels for covered dental services.

Finding a dentist in the Aetna PPO Dental network

To find a dentist in Aetna's PPO Dental network, call Aetna Member Services at 1-800-218-1458, or visit DocFind.

Predetermination of Benefits

If your dentist recommends any service or procedure that costs $250 or more, ask him or her to request a pre-determination of benefits from Aetna. This will give you an advance estimate of the amount the plan will pay in benefits and what your share may be.

Summary of Benefits

	Core Plan		Premium Plan
Plan Benefits	In Network	Out of Network	In Network	Out of Network
Annual deductible	$50 individual $150 family	$50 individual $150 family	$50 individual $150 family	$50 individual $150 family
Annual maximum benefit	$1,500 for all Covered Expenses combined (except preventive care or orthodontia)		$2,000 for all Covered Expenses combined (except preventive care or orthodontia)
Preventive care services, such as routine exams and cleanings, twice per year	100% no deductible	100% no deductible	100% no deductible	100% no deductible
Basic services such as fillings, extractions, root canals, periodontics (treatment of gums and soft tissues)	85% after deductible	80% of R&C after deductible	85% after deductible	80% of R&C after deductible
Major services such as crowns, bridges, dentures, implants	55% after deductible	50% of R&C after deductible	55% after deductible	50% of R&C after deductible
Orthodontic services	50% no deductible. Lifetime maximum benefit: $1,250		50% no deductible. Lifetime maximum benefit: $1,500

The Dental PPO deductible is waived for preventive treatment.

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