As a member of the Dental Expense Plan how can I select a dentist who will charge lower fees?

You can take advantage of a special network of over 2,500 dentists referred to as "Aetna PPO Dentists”. These dentists have contracted with Aetna Dental to use a discounted fee schedule. To find out which dentists participate, visit the Aetna website.

How are orthodontics covered under the Dental Expense Plan and DPOs?

Under the Dental Expense Plan, eligible orthodontic services are covered for members under age 19 at a 50% coinsurance level up to a lifetime benefit maximum of $1,000. Orthodontic services are only covered if the employee has been a full-time employee for at least 10 months. Under DPOs, patients under 18 years at the start of treatment have a co-payment of $1,000 or 50% of the bill (whichever is less). Patients over 18 at the start of treatment have a co-payment of $1,750 or 50% of the bill (whichever is less). There is a maximum treatment period of 24 months.

My dentist dropped out of my DPO. Can I switch dental plans?

No, if your dentist leaves your DPO, you have to select another dentist in that DPO. If after your dentist leaves, there are no other participating dentists within 30 miles of your home, you have 30 days to select another plan.

What deductibles are required by members?

Members of the Dental Expense Plan are required to satisfy a $50.00 deductible per person per calendar year. If you have family coverage, no additional deductibles are charged after any three members have each met their $50.00 deductible.

What is the annual benefit maximum under the Dental Expense Plan?

Under the Dental Expense Plan the most the plan will pay for any one person per calendar year is $3,000. This maximum applies to all eligible services except orthodontics which has a separate $1,000 lifetime benefit maximum. Members of Dental Plan Organizations (DPOs) are not subject to annual benefit maximums.

When should I request a predetermination of benefits under the Dental Expense Plan?

If you or your dependent will incur dental expenses over $300 it is strongly recommended that you ask your dentist to file a predetermination of benefits. This will ensure that you and your dentist know in advance what part of the dentist’s charges will be paid by Aetna. If you and your dentist decide on a more costly treatment method, you are responsible for the additional charges above and beyond what Aetna considers “reasonable and customary.”