Your Dental Benefits
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 in-network provider. An in-network provider will also automatically handle claims for you as well as any required predetermination of benefits. If you go to an out-of-network provider, 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 (HMSA in Hawaii) 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. TheSummary of Benefits chart below shows these maximums, as well as deductibles and benefit levels for covered dental services.
Finding a dentist in the network
To find a dentist in the network click below:
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 (HMSA in Hawaii). This will give you an advance estimate of the amount the plan will pay in benefits and what your share may be.
Dental care resources
Good dental health not only helps keep your mouth in better shape, but it's also part of your overall health and well being. Click below to learn more:
Summary of Benefits