For work that began before you were covered under the plan, The following dental services and supplies. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. For language services, please call the number on your member ID card and request an operator. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Links to various non-Aetna sites are provided for your convenience only. Replacement of teeth beyond the normal complement of 32 But your plan features and costs will vary depending on the plan you choose. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Whats covered under Medicare Advantage dental plans. CPT only Copyright 2022 American Medical Association. With our HMO-POS plans, you can enjoy all the benefits of receiving medical care through a network provider. Applicable FARS/DFARS apply. Provided by an out-of-network provider in excess of the recognized charge. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Your dental plan pays the rest. With Aetna Dental Direct, youll get the coverage you need to keep your teeth healthy. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Insurer Name: Aetna Life Insurance Company Plan Name: Aetna Dental PPO Policy Type: PPO Insurer Phone #: 1-877-238-6200 Effective Date: 01/01/2022-12/31/2022 Insurer Website: www.aetna.com THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND WHAT YOU WILL PAY FORCOVERED SERVICES. Some subtypes have five tiers of coverage. Texas Members: In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). For work-related conditions. Applicable FARS/DFARS apply. These dental benefits follow the same structure as network plans and may require you to choose a dental provider within your network. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Why choose ${company} Medicare Solutions? Visit a dentist in the Aetna Dental PPO* network. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Aetna Dental Savings Plans are NOT dental insurance and the dental savings will vary by provider, plan and zip code. With Medicare Advantage plans that include a network dental benefit, youre covered up front for specified dental services but may be required to see a dentist within your network of providers. One thing to keep in mind as you plan for dental care with this plan is that the cost of certain dental procedures and services can vary according to each provider. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. It may be different from your Aetna secure member site log in. ***Certain brands impose a no-discount policy. Dental benefits and dental insurance plans contain exclusions and limitations. For example, you pay 20%, and your plan pays 80%. The maximum deductible for 2022 is $480, but this plan (Aetna Medicare Choice Plan (PPO)) has a $200. Aetna Medicare SM Plan (PPO) Learn more about Aetna Feeling Good: Your Verizon Aetna magazine Check out Feeling good , the magazine created specifically for Verizon Aetna members. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Use order code 123AET200. The member's benefit plan determines coverage. CPT is a registered trademark of the American Medical Association. Premium deductions will start with the first full pay period - The tooth is an abutment to a covered partial denture or fixed bridge. You are now being directed to the CVS Health site. However, if you do this, you wont benefit from negotiated rates. Find the right plans and programs for you. In case of a conflict between your plan documents and this information, the plan documents will govern. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Links to various non-Aetna sites are provided for your convenience only. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. Surgical removal of impacted wisdom teeth when only for orthodontic reasons Links to various non-Aetna sites are provided for your convenience only. Learn more and see if your dentist is in the network with these plans on aetna.com. Password * Forgot Password? Unlisted, unspecified and nonspecific codes should be avoided. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. The employee pays the remainder through payroll deduction Premiums are deducted on a pre-tax basis Contact Information at Aetna Customer Service 1-877-238-6200 or www.aetna.com About the Plan Aetna Dental Summary - Effective January 1, 2023 **Through the ChooseHealthy program, which is provided by ChooseHealthy, Inc., a subsidiary of American Specialty Health Incorporated (ASH). It is not available in Montana, Vermont or Tennessee. A primary care dentist (PCD) helps guide your care with this DMO* plan. Aetna Medicare Advantage HMO-POS plans. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". First time users can also sign up and register for an account. For comprehensive services, such as fillings, extractions and crowns, the coverage varies according to plan, and you may have to pay a portion of the cost of services. The plan offers preventive treatment at 100% with no out of pocket cost. Deductible and annual maximum amounts cross-apply between in network and out of network. *Actual costs and savings vary by provider and geographic area. The Aetna Vital Savings discount program is not insurance. Routine dental care can help you have stronger teeth, healthier gums and a brighter smile. Dental information programs provide general dental information and are not a substitute for diagnosis or treatment by a dentist or other health care professional. Dental services and supplies made with high noble metals (gold or titanium) except as covered in the Eligible Dental Services section of your insurance policy You may also have to file your own claims. If more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service. The following information is about the Aetna Medicare Choice Plan (PPO) formulary (or drug list). Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Coverage for the first installation of removable dentures; fixed bridgework and other prosthetic services is subject to the requirements that such removable dentures, fixed bridgework and other prosthetic services are: needed to replace one or more natural teeth that were removed while this policy was in force for the covered person; and are not abutments to a partial denture; removable bridge; or fixed bridge installed during the prior 8 years. Enjoy discounts on hearing aids, exams and hearing aid batteries mailed to your home. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. 2022 Aetna Dental 2 Enroll at www.BENEFEDS.com . Members must make payments directly to the providers in the Aetna Vital Savings program. Aetna Student HealthSM is the brand name for products and services provided by Aetna Life Insurance Company, Aetna Health and Life Insurance Company and their affiliated companies. Preventive services such as cleanings, oral exams and X-rays are covered at 100 percent on most plans. Copyright 2015 by the American Society of Addiction Medicine. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts. Links to various non-Aetna sites are provided for your convenience only. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. 2022 . *** Terms and conditions: Bit.ly/2nlJFYG. Treating providers are solely responsible for medical advice and treatment of members. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. We encourage you to check with your participating provider prior to beginning treatment. DISCOUNT OFFERS ARE NOT INSURANCE. Dental PPO insurance plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). Aetna does not endorse any vendors, products or services associated with this program. the difference in cost between the approved less costly service and the more costly covered service. Switch by the 15th day of the current month. Choose any licensed dentist for care, but you can save by using an in-network dentist in your plan's network. 5 Visit AetnaMedicare.com to learn more about the 2022 Aetna Medicare plans. The information you will be accessing is provided by another organization or vendor. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. The ABA Medical Necessity Guidedoes not constitute medical advice. And one of the main perks of joiningaMedicare Advantage (MA)planis that many plans offer dental coverage to helpyoukeep upwithyour oral health. For PPO plans and most HMO-POS plans, you have the option to go to any licensed provider, but could save money by using a provider in the network. Rendered before the effective date or after the termination of coverage, unless coverage is continued under the Special coverage options after your plan coverage ends section of your policy. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. Message and data rates may apply.***. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. App Store is a service mark of Apple Inc. Android and Google Play are trademarks of Google LLC. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. You can change your PCD once a month on your member website. Sign up at BeneFeds.com or call 1-877-888-3337. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Enrollment in this voluntary dental plan is open to all registered students and their eligible dependents. You get a broad choice of dentists and dental providers, wellness discounts and offers that stretch your health care dollar, digital tools to easily manage your care, and more. You should: Review the Electronic Claim Vendor List Electronic Claim Vendor List. Services and supplies provided where there is no evidence of pathology, dysfunction or disease, other than covered preventive services While most dental plans require a waiting period for major services like crowns or root canals, if you switch from your existing comparable plan to an Aetna plan, we will waive the waiting period. Go to the American Medical Association Web site. Aetna Inc. and itsitsaffiliated companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. It is only a partial, general description of plan or program benefits and does not constitute a contract. Do you cover implants? The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Instead, check your benefits summary to find your share of the costs. No deductible, no claims forms and no yearly dollar limits. Includes PPO, HMO, HMO-POS medical plans with or without drugs. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. Links to various non-Aetna sites are provided for your convenience only. ZIP CODE View 2023 plans Learn about these benefits Dental, eyewear and hearing coverage is available. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Learn more about our network and DMR plans Search other providers Need a provider directory? Rates start at $7.99 a month. There also may be age and frequency limits on some services. The program does not make any payments to providers. Aetna Direct Core PPO comes with lower premiums, and Direct Preferred PPO provides more favorable splits in payment for basic procedures like fillings and extractions. Provider Directory Last Updated: April 22, 2023 Page Last Updated: January 27, 2023 If you do not intend to leave our site, close this message. You are now being directed to CVS Caremark site. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Our plan selection pages will be down for maintenance starting Friday, April 16, at 9 p.m. and returning by 1 p.m. Saturday, April 17. Give your member information at your visit. Aetna Dental Direct insurance plan is offered by Aetna Life Insurance Company (Aetna). The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Aetna Dental has over 60 years of experience offering dental benefits. Note not all plans and offers available in all markets. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Does your dental plan have a missing tooth clause? Were bringing you to our trusted partner to help process your payments. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. See your PCD for regular exams and to get referrals if you need specialty care. Top 3 reasons to choose Aetna Dental However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Student health insurance plans are underwritten by Aetna Life Insurance Company (Aetna). In excess of the benefit, dollar, day, visit, or supply limits stated in your schedule of benefits. Aetna Dental provides national network coverage for Prince George's County Government through two networks: You receive greater benefit coverage when you use a provider who participates in the Aetna Dental participating network. This means you pay nothing out of pocket if you stay in network. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Aetna handles premium payments throughInstaMed, a trusted payment service. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". It's generally available starting in September and describes costs and benefits of your plan that will take effect on January 1 of the following year. FEDVIP Program Highlights A Choice of Plans and . your primary care dentist will refer you to one in our network. CPT is a registered trademark of the American Medical Association. When billing, you must use the most appropriate code as of the effective date of the submission. Reprinted with permission. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. How to enroll: Do you want to continue? Send the form with the receipt to the claims address found on your member ID card. Knowing more about your plan can help you get the most from your benefits and covered services. Studies show that a healthy mouth helps you avoid health problems in the body, too. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). The plan offers preventive treatment at 100% with no out of pocket cost. Youcansee anylicenseddental provider in the U.S. You can use the allowance toward almost all dental services except for teeth whitening and a few administrative costs (e.g., missed appointments). Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Language services can be provided by calling the number on your member ID card. Each main plan type has more than one subtype. Actual costs and savings may vary by provider, service and geographic location. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. We make dental care convenient. Visit the secure website, available through www.aetna.com, for more information. Aetna Student Health Agency Inc. is a duly licensed broker for student accident and health insurance in the Commonwealth of Massachusetts. So, your share of the cost is usually lower. You are now being directed to the CVS Health site. Click the Register button to get started. Dual Enrollment If you sign up for a dental and/or vision plan during the 2022 Open Season, your coverage will begin on January 1, 2023. your coverage will begin on January 1, 2022. You are leaving our Medicare website and going to our non-Medicare website. Get lower rates when you go to a dentist thats in your PPO network. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Treating providers are solely responsible for dental advice and treatment of members. ${tty} to chat about any Medicare questions you have. The change will start the first day of the next month. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. You can start using your plan right away! Most of our HMO-POS plans require you to use a network provider for medical care but provide you with flexibility to go to licensed dentists in or out of network for routine dental care. Digital tools to easily manage your care and access your ID card whenever needed. The AMA is a third party beneficiary to this Agreement. If you enroll in an Aetna Medicare Advantage plan that includes dental coverage, some of the services that may be covered include: Teeth cleaning, scaling and polishing Office visits for oral examinations Non-surgical extractions Fillings Minor denture adjustments X-rays Oral hygiene instruction Dietary advice and counseling Minor bite adjustments When billing, you must use the most appropriate code as of the effective date of the submission. Copyright 2015 by the American Society of Addiction Medicine. If you do not intend to leave our site, close this message. CPT only copyright 2015 American Medical Association. Just check with your employer to see which plans are available to you. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). Alternate Treatment Rule ** Out-of-network benefits are paid based on recognized charge levels, as determined by Aetna and specified in your plan documents. Out of network: 4. . In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. Please consult with the respective plan detail page for additional plan terms.

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