aetna dental ppo coverage 2022
You are now being directed to the CVS Health site. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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. Links to various non-Aetna sites are provided for your convenience only. If you need a PDF document in an accessible format, you can request it directly through"Contact Us" here or at the top of the page. Aetna Inc. and its affiliated 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. Digital tools to easily manage your care and access your ID card whenever needed. Your dental plan pays the rest. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. It may be different from your Aetna secure member site log in. Instruction for diet, plaque control and oral hygiene The member's benefit plan determines coverage. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. 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. . 2022 - 2023 Aetna PPO Dental Plan Design and Benefits Summary Visit any licensed dentist - in or out of network In network: Visit a dentist in the Aetna Dental PPO* network. Claims must be submitted within 365 days of the date you received the service. CPT only Copyright 2022 American Medical Association. Please be sure to add a 1 before your mobile number, ex: 19876543210. Acupuncture, acupressure and acupuncture therapy Network dentists offer special rates for covered services. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. The maximum deductible for 2022 is $480, but this plan (Aetna Medicare Choice Plan (PPO)) has a $200. Brushing, flossing and getting regular dental checkups help to keep your mouth healthy. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. If you do not intend to leave our site, close this message. The three carriers providing service to the District's employees are CompBenefits/Humana (Basic and Enhanced PPO/Indemnity and DHMO Managed Care), Aetna (Basic and Enhanced PPO/Indemnity), and Aetna (Basic and Enhanced DHMO Managed Care). With Aetna Dental Direct, you'll get the coverage you need to keep your teeth healthy. Information is believed to be accurate as of the production date; however, it is subject to change. 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. Language services can be provided by calling the number on your member ID card. We make dental care convenient. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. To check that your provider participates, visit our website or call us. Thats it. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. - It is treatment for decay or traumatic injury and teeth cannot be restored with a filling material Not available in many states. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Aetna Inc. and its affiliated 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. Premium deductions will start with the first full pay period For example, you pay 20%, and your plan pays 80%. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Youre given an annual allowance to spend on dental care. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Temporomandibular joint dysfunction/disorder. Links to various non-Aetna sites are provided for your convenience only. Out of network: Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). 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. If treatment is being given by a participating dental provider and the covered person asks for a more costly covered service than that for which coverage is approved, the specific copayment for such service will consist of: the copayment for the approved less costly service; plus All Rights Reserved. However, if you do this, you wont benefit from negotiated rates. FEDVIP Program Highlights A Choice of Plans and . A Nationwide Dental PPO Plan Who may enroll in this plan: All Federal employees, annuitants, and . For language services, please call the number on your member ID card and request an operator. This Agreement will terminate upon notice if you violate its terms. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". The SBC shows you how you and the plan would share the cost for covered health care services. Rates start at $7.99 a month. 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. The replacement of; addition to; or modification of: existing dentures; crowns; casts or processed restorations; removable denture; fixed bridgework; or other prosthetic services is covered only if specific criteria are met. First time users can also sign up and register for an account. Some plans cover comprehensive services. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. That are not medically necessary. Accessibility Services:If you are a person with a disability who needs assistance using our websites, our Customer Service Representatives can assist you. The Appointment of Representative form is on CMS.gov. Taking care of your teeth is as an important part of taking care of your health. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The dental discounts are available through participating healthcare providers only. Click the Register button to get started. The EOC is the legal contract between you and the Medicare plan. In case of a conflict between your plan documents and this information, the plan documents will govern. You may also have to file your own claims. Aetna Dental PPO Plan More reasons to smile Worldwide dental coverage and plans with no deductible New Hires have 60 days to choose benefits. But your plan features and costs will vary depending on the plan you choose. Check your Evidence of Coverage (EOC) for more details. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Youll need to select a primary care dentist in the DMO network. Aetna Inc. and itsaffiliated 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. This material is for information only. The school has chosen a plan that makes it easy to keep your smile. Check your plan's Evidence of Coverage. Due to therelatively high out-of-pocket costs for these procedures, some older adultsend up forgoing necessary dental care. You can choose from thousands of dental providers nationwide, including those who offer virtual dental visits. Aetna will expand the Total Choice dental benefit introduced in 2022 to additional Individual MA HMO-POS and PPO plans. Is there a maximum dental benefit? Very low rates. Whats covered under Medicare Advantage dental plans. Message and data rates may apply.***. Caring for your teeth should never feel out of reach with Aetna Dental Direct. If you do not intend to leave Aetna Medicare, close this message. Enjoy discounts on hearing aids, exams and hearing aid batteries mailed to your home. Cigna DPPO plan features 1. New and revised codes are added to the CPBs as they are updated. Overall, it is very affordable compared to competitors and comes with many different amounts of coverage. Or it may be coinsurance, which is a percentage of the dentists charge. How is coverage handled overseas? Choose a PCD from our network**: Use ourprovider search toolto find one. 5. Treating providers are solely responsible for medical advice and treatment of members. Visit any licensed dentist outside the network. Dental insurance plans contain exclusions and limitations. Altius Health Plans: HMO (PDF) - UT, ID (Southwest & Eastern), WY (Uinta County) HDHP (PDF) - UT, ID (Southwest & Eastern), WY (Uinta County) For information about our plans available through the Federal Employees Dental and Vision Insurance Program (FEDVIP), please visit our Dental PPO Plan site or our Aetna Vision Preferred plan site. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-877-698-4825, is the Discount Medical Plan Organization. Aetna handles premium payments through Payer Express, a trusted payment service. 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. Others have four tiers, three tiers or two tiers. **Through the ChooseHealthy program, which is provided by ChooseHealthy, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Treating providers are solely responsible for medical advice and treatment of members. Get coverage to any doctor (in or out-of-network) at the same member cost share. Preferred Provider Organization (PPO) plans. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). To view the form just select Continue. You are now being directed to the CVS Health site. 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. Plan 41 Effective Date: 01-01-2022 Hampshire, Middlesex, Norfolk, Plymouth, Suffolk and Worcester. A primary care dentist (PCD) helps guide your care with this DMO* plan. Studies show that a healthy mouth helps you avoid health problems in the body, too. With adirect member reimbursementallowance, youre givena set amount of money to spend each year on dental care.. **Out-of-network benefits vary by state and are subject to certain charge limits. Applicable FARS/DFARS apply. Dental implants, false teeth, prosthetic restoration of dental implants, plates, dentures, braces, mouth guards, and other devices to protect, replace or reposition teeth and removal of implants Members must make payments directly to the providers in the Aetna Vital Savings program. So, your share of the cost is usually lower. With a PPO plan, you can visit any dentist you want (whether they are in or out of the network) and usually receive some coverage level. Print dental claim form (English) Original Medicare, on the other hand, does not coverroutinedental care, such as cleanings, X-rays,andfillings. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Dental care, eyewear and hearing aids Many of our Medicare Advantage plans include dental, eyewear and hearing benefits. Replacement of a device or appliance that is lost, missing or stolen, and for the replacement of appliances that have been damaged due to abuse, misuse or neglect and for an extra set of dentures To learn more about using your Aetna MA dental benefits, read our guide below. Do you cover adult orthodontia? 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). Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). The plan offers both network (DMO) or out-of-network (PPO) coverage. 1999- Sign up at BeneFeds.com or call 1-877-888-3337. 2022 - 2023 Aetna PPO Dental Plan Design and Benefits Summary. Why choose ${company} Medicare Solutions? You pay up front for dental care and submit receipts for reimbursement. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Orthodontic treatment except as covered in the Eligible Dental Services section of your insurance policy 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. Under the Dental Preferred Provider Organization (PPO) plan, you may choose at the time of service either a PPO participating dentist or any nonparticipating dentist. 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). Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. Aetna Dental plans come with special perks and discounts, including exclusive offers from CVS Health. Your InstaMed log in may be different from your Caremark.com secure member site log in. Links to various non-Aetna sites are provided for your convenience only. the difference in cost between the approved less costly service and the more costly covered service. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Network dentists also file claims for you. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 2023 DentalPlans.com, Inc. All Rights Reserved. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". You may pay more when you get care from dentists who arent in the network.**. You can also download it from the App Store or the Google PlayTM store. Get discounts on oral health care products like Z Sonic toothbrushes, replacement brush heads and various oral health care kits. We've broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. Applicable FARS/DFARS apply. Knowing more about your plan can help you get the most from your benefits and covered services. Want to see options for a different location? Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. If youre unable to print out the form, you can write out all the required information on a piece of paper and send it with your receipts. Aetna Medicare is a HMO, PPO plan with a Medicare contract. Aetna Invisalign Coverage Your Aetna plan might cover your Invisalign treatment, although it depends entirely on the plan. It gives members access to discounted fees according to schedules negotiated with providers by Aetna Life Insurance Company for Aetna Vital Savings. It does not meet the Minimum Creditable Coverage requirements in Massachusetts. . Aetna is continuing to expand the Aetna Dental PPO network across the country to . Aetna does not provide dental, medical, vision or other health care/treatment. By texting 90156, you consent to receive a one-time marketing automated text message from Aetna with a link to download the Aetna Health app. 2022 . Applicable FARS/DFARS apply. This is donethrough an optional supplemental benefit. Note not all plans and offers available in all markets. 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. See dentists both in and out of our network. Alternate Treatment Rule This may be a copay, which is a set dollar amount. This is the total amount per person your plan will pay toward the in-network cost of dental care each year. 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. 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. Unlisted, unspecified and nonspecific codes should be avoided. Surgical removal of impacted wisdom teeth when only for orthodontic reasons These typically include some level of dental coverage, including twice-yearly oral health exams, teeth. Reprinted with permission. 2022 Aetna Dental 2 Enroll at www.BENEFEDS.com . No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. As of April 4, 2022, Medicare covers up to eight over-the-counter COVID-19 tests each month, at no extra cost to you if you have . Links to various non-Aetna sites are provided for your convenience only. 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). Selection of a program provider is also the responsibility of the participant and is not based on any representations by Aetna. Do you want to continue? If your MA plan doesnt include dental coverage, or you want to increase your coverage, you may have the option to purchase dental benefits for an additional monthly premium. There is one exception, however:If you needmedicaldental procedures whileyourein the hospital, Medicare may pay for those services as part of Medicare Part A (hospital insurance). * In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). 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. Member Services: 1-877-238-6200 Get the Aetna Health app by texting GETAPP to 90156 for a link to download the app and create an account.