The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. 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). Reprinted with permission. For more information, please call HSA Consulting Customer Service at (888) 978-8355. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Coverage Period: 01/01/2022 - 12/31/2022 Coverage for: Self Only, Self Plus One or Self and Family | Plan Type: PPO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Dental PPO insurance plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). Aetna Dental Savings Plans are NOT dental insurance and the dental savings will vary by provider, plan and zip code. Since there is no paperwork or reimbursement, you must pay for the service at the time its provided. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Orthodontic treatment except as covered in the Eligible Dental Services section of your insurance policy You can also submit paper claims. Tooth Missing But Not Replaced Rule You should: Review the Electronic Claim Vendor List Electronic Claim Vendor List. 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. Just show your discount card at your appointment and you'll get instant savings 15 percent to 50 percent off the cost of most services*. These dental benefits follow the same structure as network plans and may require you to choose a dental provider within your network. CPT is a registered trademark of the American Medical Association. Aetna Medicare Advantage HMO-POS plans. Remember Username Secure Login First time here? So, your share of the cost is usually lower. Dental network Direct Member Reimbursement (DMR) Not sure If you're covered through a former employer, union, trust or other retirement system, then you have a dental network plan and are covered by the Aetna Dental PPO network. . We've broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. 1According to the Aetna Enterprise Provider Database as of May 1, 2018. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Want to see options for a different location? 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. Some preferred provider organization (PPO) and health maintenance organization point-of-service (HMO-POS) plans, however, do allow you to see any licensed dental provider, but you may save money by seeing a provider in our network. If you enroll in an Aetna Medicare Advantage plan that includes dental coverage, some of the services that may be covered include: Teeth cleaning, scaling and polishing Office visits for oral examinations Non-surgical extractions Fillings Minor denture adjustments X-rays Oral hygiene instruction Dietary advice and counseling Minor bite adjustments *Based on January 2023 Aetna provider data Whats covered under Medicare Advantage dental plans. A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl. And you dont have to have Aetna medical or other coverage with us to purchase. Aetna Inc. and itsitsaffiliated 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. Original Medicare, on the other hand, does not coverroutinedental care, such as cleanings, X-rays,andfillings. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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. Dental care, eyewear and hearing aids Many of our Medicare Advantage plans include dental, eyewear and hearing benefits. 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. And withAetna MA plans, you have a variety of options to make it more affordable and easierto keep up withyourdental care. You may also have to file your own claims. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Switch by the 15th day of the current month. Teeth whitening and facings on molar crowns and pontics will always be considered cosmetic. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Network dentists also file claims for you. Actual costs and savings may vary by provider, service and geographic location. While most dental plans require a waiting period for major services like crowns or root canals, if you switch from your existing comparable plan to an Aetna plan, we will waive the waiting period. Treating providers are solely responsible for dental advice and treatment of members. The following information is about the Aetna Medicare Choice Plan (PPO) formulary (or drug list). But your plan features and costs will vary depending on the plan you choose. Some subtypes have five tiers of coverage. Legal notices Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). 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. Aetna Vital Savings provides participants with access to a network of independent practicing providers. your coverage will begin on January 1, 2022. We make dental care convenient. If you do not intend to leave our site, close this message. In case of a conflict between your plan documents and this information, the plan documents will govern. PLAN EXCLUSIONS AND LIMITATIONS* The change will start the first day of the next month. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". How we make it simple for you About Medicare Advantage We're here to help you learn more about what you can get out of Medicare Advantage. Want to learn more about your dental coverage? For comprehensive services, such as fillings, extractions and crowns, the coverage varies according to plan, and you may have to pay a portion of the cost of services. This is the total amount per person your plan will pay toward the in-network cost of dental care each year. If you are already an Aetna Dental Insurance Member and have a question regarding your existing policy or claim, please visit Aetna.com or call 1-800-872-3862 I have a question about billing Topic* Please select a topic for your inquiry Billing Question Other Participating dentists have agreed to provide services at a negotiated rate for covered services. 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. Pricing starts at $20 in most regions, and also includes: No waiting periods Inclusive plans. Aetna dental insurance comes with stand-alone dental coverage or dental, vision, and hearing coverage. Aetna Dental has over 60 years of experience offering dental benefits. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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. Links to various non-Aetna sites are provided for your convenience only. Instruction for diet, plaque control and oral hygiene Aetna Dental Coverage | New York State Nurses Association Home Aetna Dental Coverage For more information on NYSNA dental benefits, offered through Aetna, please refer to the following documents ( .pdf; Adobe Acrobat Reader required): Aetna Navigator Website Introduction Aetna PPO Overview Dental Benefits Summary (NYSNA Full-time RNs) Provided by an out-of-network provider in excess of the recognized charge. Aetna Dental Direct PPO Plans are Subject to the Following Rules: Replacement Rule You can find a network provider by logging in as a member and going to our provider directory. Routine dental care can help you have stronger teeth, healthier gums and a brighter smile. Aetna Medicare is a HMO, PPO plan with a Medicare contract. ZIP CODE View 2023 plans Learn about these benefits Dental, eyewear and hearing coverage is available. So, your share of the cost is usually lower. 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). Members should discuss any matters related to their coverage or condition with their treating provider. Dual Enrollment If you sign up for a dental and/or vision plan during the 2022 Open Season, your coverage will begin on January 1, 2023. Im turning 65 or just starting to explore Medicare. Choose a PCD from our network**: Use ourprovider search toolto find one. Cigna DPPO plan features 1. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. offering the same type of coverage; i.e., you (or covered family members) cannot be covered by two FEDVIP dental plans or two FEDVIP vision plans. Find your dentist now in Aetna's large nationwide network. Password * Forgot Password? Save on gym memberships, health coaching, fitness gear, wearable fitness devices, group fitness on demand and more. Do you cover adult orthodontia? However, if you do this, you wont benefit from negotiated rates. - It is treatment for decay or traumatic injury and teeth cannot be restored with a filling material If your plan doesnt include dental coverage, or you want to increase your coverage, you may have the option to purchase dental benefits with an additional monthly premium (coverage varies by plan). There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. That are not medically necessary. Visit any licensed dentist outside the network. 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 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). Network dentists offer special rates for covered services. All Rights Reserved. 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). Section 5 Dental Services and Supplies Class A Basic 16 . No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Very low rates. 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. Click the Register button to get started. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. The maximum deductible for 2022 is $480, but this plan (Aetna Medicare Choice Plan (PPO)) has a $200. All Rights Reserved. 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). Out of network: Aetna may receive a percentage of the fee you pay to the discount vendor. Some subtypes have five tiers of coverage. 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. 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. * In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). This Agreement will terminate upon notice if you violate its terms. Most of our HMO-POS plans require you to use a network provider for medical care but provide you with flexibility to go to licensed dentists in or out of network for routine dental care. Check your plan's Evidence of Coverage. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. You have the freedom to care for your smile your way with this PPO plan. The employee pays the remainder through payroll deduction Premiums are deducted on a pre-tax basis Contact Information at Aetna Customer Service 1-877-238-6200 or www.aetna.com About the Plan Aetna Dental Summary - Effective January 1, 2023 Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. But your plan features and costs will vary depending on the plan you choose. The member's benefit plan determines coverage. 5 Visit AetnaMedicare.com to learn more about the 2022 Aetna Medicare plans. CPT is a registered trademark of the American Medical Association. Note not all plans and offers available in all markets. Aetna handles premium payments through InstaMed, a trusted payment service. It is only a partial, general description of plan or program benefits and does not constitute a contract. are covered at 100% on most plans. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Information is believed to be accurate as of the production date; however, it is subject to change. The EOC is the legal contract between you and the Medicare plan. Aetna's 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). You may also be required to pay a portion of the costs. Dental benefits and dental insurance plans contain exclusions and limitations. Enrollment in this voluntary dental plan is open to all registered students and their eligible dependents. All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Premium deductions will start with the first full pay period Others have four tiers, three tiers or two tiers. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. The plan offers preventive treatment at 100% with no out of pocket cost. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. CPT only copyright 2015 American Medical Association. Plan 41 Effective Date: 01-01-2022 Hampshire, Middlesex, Norfolk, Plymouth, Suffolk and Worcester. Direct member reimbursement allowance: How to get reimbursed for dental care. Si tu intencin no era salir del sitio web, cierra este mensaje. Do you cover implants? However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Rates start at $7.99 a month. Youcansee anylicenseddental provider in the U.S. You can use the allowance toward almost all dental services except for teeth whitening and a few administrative costs (e.g., missed appointments). California license number: OB84599. By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. With our HMO-POS plans, you can enjoy all the benefits of receiving medical care through a network provider. 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. So, you wont see cost information here. The SBC shows you how you and the plan would share the cost for covered health care services. The ABA Medical Necessity Guidedoes not constitute medical advice. This Agreement will terminate upon notice if you violate its terms. Your dental plan may have yearly and lifetime limits on coverage. For additional language assistance: Choose from more than 120,000 dental providers nationwide, including providers who offer virtual visits through tele-dentistry. If you do not intend to leave the Medicare site, close this message. 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. All Rights Reserved. You are now being directed to CVS Caremark site. Insurer Name: Aetna Life Insurance Company Plan Name: Aetna Dental PPO Policy Type: PPO Insurer Phone #: 1-877-238-6200 Effective Date: 01/01/2022-12/31/2022 Insurer Website: www.aetna.com THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND WHAT YOU WILL PAY FORCOVERED SERVICES. This information is neither an offer of coverage nor medical advice. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Pediatric dental essential health benefits include frames for glasses for pediatric patients; the discount for frames may duplicate benefits if you are enrolled in a vision plan that covers your dependent children. There are no claims or referrals to worry about, and no limits on how much you can save. Aetna Dental provides national network coverage for Prince George's County Government through two networks: You receive greater benefit coverage when you use a provider who participates in the Aetna Dental participating network. Deductible and annual maximum amounts cross-apply between in network and out of network. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. 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. 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. The information you will be accessing is provided by another organization or vendor. This benefit maximum can range from about $150 to $6,000. 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. Covered family members can choose their own PCDs. You are leaving our Aetna Medicare website and going to an Aetna Medicaid website. Allow approximately 4-6 weeks for reimbursement. Taking care of your teeth is as an important part of taking care of your health. View your plan details. It is only a partial, general description of plan or program benefits and does not constitute a contract. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. When you see a dental care provider for services, you pay up front and get a receipt that includes a description of the services provided. Treating providers are solely responsible for medical advice and treatment of members. It is not available in Montana, Vermont or Tennessee. As you plan for your dental care, keep in mind that you may have limits on the amount of preventive care visits you can make each year, as well as caps on coverage for comprehensive services. Dentures, crowns, inlays, onlays, bridges, or other appliances or services used for the purpose of splinting, to alter vertical dimension, to restore occlusion, or correcting attrition, abrasion, or erosion For which you have no legal obligation to pay. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. SBBC now offers the option of four dental plans available from three dental carriers. The availability of a particular provider cannot be guaranteed and provider network composition is subject to change. 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. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. Massachusetts license number: 10041444. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Print and fill out the reimbursement form. Get a discount on blood pressure montiors, pedometers, activity trackers, pain relief devices and other Omron products. Get the coverage you need to keep your mouth, teeth and gums healthy. Network dentists offer special rates for covered services. Purchasing the Aetna dental discount cards is easy - online, by mail or by phone. ***Certain brands impose a no-discount policy. 151 Farmington Avenue, Hartford, CT 06156. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Get savings on weight-loss programs and meal plans, and enjoy one-on-one help, personalized menus, online tools and chat rooms. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Choose from leading manufacturers and get free follow-up service for one year. Visit your PCD: If you see someone other than your selected PCD, you could end up paying more. Member Services: 1-877-238-6200 They also have Direct Preventive, which only covers the costs of preventive dental care. Sign up at BeneFeds.com or call 1-877-888-3337. That are experimental or investigational. Aetna does not endorse any vendors, products or services associated with this program. Privacy policy: Aetna.com/legal-notices/privacy.html. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. Unlisted, unspecified and nonspecific codes should be avoided. Learn about Medicare Advantage The plan offers preventive treatment at 100% with no out of pocket cost. Disclaimer of Warranties and Liabilities. You pay up front for dental care and submit receipts for reimbursement. See your PCD for regular exams and to get referrals if you need specialty care. Others have four tiers, three tiers or two tiers. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. It's generally available starting in September and describes costs and benefits of your plan that will take effect on January 1 of the following year. Knowing more about your plan can help you get the most from your benefits and covered services. 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. The member's benefit plan determines coverage. 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. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Get lower rates when you go to a dentist thats in your PPO network. The Aetna Dental Direct plan covers preventative care 100% with no out of pocket cost. First time users can also sign up and register for an account. Aetna is continuing to expand the Aetna Dental PPO network across the country to . A Nationwide Dental PPO Plan Who may enroll in this plan: All Federal employees, annuitants, and . 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). Annual Deductible $50 Per Person $150 Per Family, per calendar year, Annual Maximum Benefit $1,250 per covered person. Once youre a member, heres how you can connect: 1. It does not meet the Minimum Creditable Coverage requirements in Massachusetts. This search will use the five-tier subtype. Preventive services (cleaning, x-rays, exams, etc.) Disclaimer of Warranties and Liabilities. Persons with a hearing or speech disability can use 711 for Telecommunications Relay Service (TRS). 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. 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. Get coverage to any doctor (in or out-of-network) at the same member cost share. 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. You get access to discounts off the regular charge on products and services offered by third-party vendors and providers. We're here 8 a.m. - 8 p.m., Monday through Friday.