Core and Premium PPO Dental Plans

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 below 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.

Dental Member Video

Click here to view a video of the dental plans. This video utilizes the Aetna Personal Benefits Advisor (also referred to as Jellyvision) voice of David to explain how each plan works as well as its advantages. Using humor and some real life examples, David answers some common questions about the dental plans and breaks down information into easy to understand language. The video is approximately four minutes.

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.