Download Two dental plans in one

dental PLAN
Aetna Dental® Freedom of Choice Plan
Two dental plans in one
Freedom to switch between
dental plans if you change
your mind
09.03.300.1 J (8/11)
You have the freedom to switch
dental plans if you change your mind
Which will you choose?
Will it be the DMO benefits and
insurance plan or the PPO insurance
plan?* Begin the year by selecting the
plan that is right for you. If your needs
change later in the year, switch to the
other plan. It’s that simple. You can
switch plans every month if that works
for you.
Switching plans is easy
Making the switch is just a call or click
away. Just call Member Services, or log in
to your secure member website, which
you can access after you enroll.
Switch by the 15th day of the current
month to be effective the 1st day of the
next month.**
Choice #1: The Dental
Maintenance Organization
(DMO®) plan***
Choice #2: The Preferred
Provider Organization
(PPO) plan
Key highlights
Key highlights
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enerally, lower out-of-pocket costs
G
than PPO
primary care dentist (PCD)
A
coordinates your care
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enerally, higher out-of-pocket costs
G
than DMO
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Visit any licensed dentist
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No referrals
et a referral to see a specialist.
G
If your plan includes orthodontic
coverage, you will not need referrals
for orthodontic care.
T ypically no out-of-pocket costs for
preventive care
o annual deductibles or annual dollar
N
maximums
*See your plan documents for a complete list of benefits, exclusions and limitations for each plan. Check your Summary of Benefits to see how much you pay for
covered services. Out of network benefits are paid based on usual and prevailing charge or recognized charge levels, as determined by Aetna and specified in
your plan.
**Your primary care dentist keeps a list of eligible patients that is updated monthly. Your name will appear on this list when it is updated the month after your
selection. Some dentists will only treat patients who appear on this printed monthly roster. Call the Member Services number on your Aetna ID card if your
dentist needs to confirm your eligibility.
***State laws vary with regard to out-of-network benefits. Some states allow limited benefits when you go out of network for covered services. Check your plan
documents for details. In Illinois, DMO plans provide limited out-of-network benefits. However, to receive maximum benefits, members must select and have
care coordinated by a participating primary care dentist. In Illinois, the DMO plan is not an HMO. In California, your dentist may refer you to out-of-network
dentists for some services. Check your plan documents for details.
DMO dental benefits and insurance plans are underwritten by Aetna Dental Inc., Aetna Dental of California Inc., Aetna Health Inc. and/or Aetna
Life Insurance Company; in Texas by Aetna Dental Inc.; and in Arizona by Aetna Health Inc. The Dental PPO insurance plan is underwritten and/or
administered by Aetna Life Insurance Company (Aetna). Each insurer has sole financial responsibility for its own products.
How the DMO plan works
How the PPO plan works
Preventive and routine services
All services
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P ick a PCD from the Aetna DMO
network.* Each family member can
choose a different PCD. Change your
PCD as often as once a month.
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isit your PCD for regular cleanings
V
and basic services.
S how your Aetna ID card when you go
to the dentist.
T here is no deductible with the DMO
plan. You may have to pay a copay
(a flat dollar amount) at the time
of service.
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our participating dentist files claims
Y
for you. There are no other bills for you
to pay.
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Specialty care
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our PCD will refer you to specialists
Y
when needed. Referrals are often done
electronically so there’s no paperwork
for you to handle.
If your plan includes orthodontic
coverage, you will not need a referral
for orthodontic care.
Emergency care
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all your PCD if you need emergency
C
care.
If you’re outside your covered service
area, call Member Services and we’ll
help you find a dentist who can help.
The number is on your Aetna Dental
ID card.
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hoose any licensed dentist for basic,
C
specialty or emergency care. You never
need a referral to see a specialist.
If you pick a dentist from the Aetna
PPO network, you’ll generally pay less.
That’s because network dentists
negotiate special rates for Aetna
members.
ou may have a deductible. This is an
Y
amount you must pay for your dental
care before the plan begins to pay.
fter you meet your deductible, you
A
may have to pay a coinsurance. That
means you’ll pay a share of covered
expenses at the time of service.
n out-of-network dentist may charge
A
you the difference between the
amount covered by your plan and the
amount charged for the dental service.
ou may have to file your own claim
Y
forms. Just download and print from
your secure Aetna Navigator® website.
See back for details.
T here are annual and lifetime coverage
maximums. So whenever possible, see
a network dentist to pay less.
See if your dentist is in
the network
There are two ways to find a participating
dentist if you prefer Choice #1:
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nline — visit our DocFind® directory
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at www.aetna.com.
y phone — after you enroll, you can
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call Member Services at the toll-free
number on your Aetna ID card.
Dental benefits online and on the go
Your secure, personalized,
member website
Look up facts and articles about
dental care
Got mobile web? Get dental
information
Once you enroll, you’ll have access to our
secure Aetna Navigator® member website
at www.aetna.com. This personalized
benefits management tool is the first
place to go when you need to:
Here’s just some of what you can do
when you visit www.aetna.com and
www.simplestepsdental.com:
Even when you’re on the go, you can
link up to your online dental information.
You can:
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Switch to the other plan
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Download and print a claim form
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iew a past explanation of benefits
V
statement
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See who’s covered by your plan
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Send us an e-mail, and more
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ead articles and get facts about over
R
50 dental conditions and treatments
se the Ask the Dentist feature to
U
answer your specific questions
E xplore online tools that make it easy
to use your dental plan
L earn how to prevent a dental problem
before it begins
Give yourself the option to switch.
Enroll in the Aetna Dental Freedom of Choice
plan today!
This material is for information only and is not an offer or invitation to contract. You must complete an
application to get coverage. Rates and benefits vary by location. Dental information programs provide
general dental information and are not a substitute for diagnosis or treatment by a dentist or other dental
care professional. Dental providers are independent contractors and are not agents of Aetna. Provider
participation may change without notice. Aetna does not provide care or guarantee access to dental
services. Dental benefits and dental insurance plans contain exclusions and limitations. Not all dental
services are covered. See plan documents for a complete description of benefits, exclusions, limitations and
conditions of coverage. Plan features and availability may vary by location and/or group size and are subject
to change. Information is believed to be accurate as of the production date; however, it is subject to change.
For more information about Aetna plans, refer to www.aetna.com.
Policy forms issued in Oklahoma include: GR-9/GR-9N, GR-23, GR-29 and/or GR-29N.
©2011 Aetna Inc.
09.03.300.1 J (8/11)
www.aetna.com
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L ook up a specialist from your dentist’s
office
Find driving directions to get you there
S ee who’s covered under your plan —
anytime, anywhere you need to know
Contact us in a snap!