Dental services covered and amount paid by plan - In-Network Coverage*
Print Application Form |
Aetna PPO Plus pays
 |
Aetna PPO pays
|
Diagnostic and preventive |
100% not subject to deductible |
80% not subject to deductible |
Periodontal maintenance cleanings |
80% |
50% |
Denture repair, rebase and relining |
80% |
50% |
Basic restorative (fillings) |
50% |
50% |
Oral surgery |
50% |
50% |
Endodontics (root canals) |
50% |
50% |
Additional coverage |
|
|
Periodontics |
50% |
50% |
Crown and cast restorations |
50% |
50% |
Prosthodontics (dentures) |
50% |
50% |
Temporomandibular joint (TMJ) dysfunction |
Not covered |
Not covered |
Dental accident |
N/C |
N/C |
Lifetime maximum - dental accident |
N/A |
N/A |
Deductibles and maximums per member enrolled |
|
|
Deductible (calendar year) |
$50 |
$100 |
Maximum benefi t (calendar year) |
$1,200 |
$1,000 |
Waiting period |
|
|
Basic |
6 months |
6 months |
Major |
18 months |
18 months |
* Nonpreferred (Out-of-Network) Coverage is limited to a maximum of the Plan's payment, which is based on the contracted maximum fee for participating providers in the particular geographic area. Above list of covered services is representative. Not all services are covered. See plan documents for a full list of exclusions and limitations.
Aetna Advantage Plans for individuals, families and the self-employed are underwritten by Aetna Life Insurance Company ( Aetna ) directly and/or through an out of state blanket trust. In some states, individuals may qualify as a business group of one and may be eligible for guaranteed issue, small group health plans.
