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Aetna Dental PPO
The PPO Dental Plan option allows you to receive care from any dental provider. However, if you receive dental care from an Aetna PPO provider, you will pay less because these providers' fees are generally lower and are within reasonable
and customary limits.
The charts below highlight the key benefits of the Aetna PPO Dental
Plan:
| Annual Deductible |
$50 per person, $100 per family
|
|
Annual Maximum Benefit
|
$1,500 per person, $3,000 per family
(does not apply to orthodontia) |
| Preventative / Diagnostic Care — Cleanings,
routine x-rays, routine exams, and fluoride treatments |
Covered at 100%, deductible waived |
Covered at 100% of R&C,
deductible waived |
| Basic Restorative Care — Fillings,
general anesthesia, sealants, endodontics, periodontics, prosthetic
repairs, and space maintainers |
Covered at 80%, after deductible |
Covered at 80% of R&C,
after deductible |
|
Major Restorative Care — Crown / bridges, onlays,
bridgework, inlays, and dentures
|
Covered at 50%, after deductible |
Covered at 50% of R&C,
after deductible |
|
Orthodontics ($2,000 per person lifetime maximum)
|
Covered at 50%, after deductible
|
Covered at 50% of R&C,
after deductible |
Frequencies
| Exams |
Two routine exams per calendar year. Exams do not need to
be six months apart.
|
|
Cleanings
|
Two routine cleanings per calendar
year. Cleanings do not need to be six months apart. |
| Bitewing X-Rays |
Two bitewing x-rays per calendar
year. Bitewing x-rays do not need to be six months apart. |
| Fluoride Treatments |
Dependent children up to age 17 are
covered for two applications per calendar year. Fluoride applications
do not need to be six months apart. |
|
Complete X-Ray Series
|
One complete set of x-rays once every
three years. |
|
Periodontic Scaling and Root Planing or Subgingival Curettage
|
Four separate quadrants per calendar year.
|
| Sealants |
Dependent children up to age 15 are
covered for sealants for permanent bicuspids and molars. |
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