Dental Plan Questions

Can I go to any dentist?

Yes, you may use any dentist you want. However, If the dentist is a Aetna participating dentist they will file all claims and they agree to charge you what Aetna says is reasonable and customary. If the dentist is not a Aetna participating dentist you will be required to pay the dentist yourself, file all your own claims, and you may pay a higher cost.

Do I have to pay for services up-front and then get reimbursed?

If you receive care from a Aetna participating dentist, you will usually be charged only your deductible and co-insurance amount. Aetna will pay the rest to the dentist directly.

What is the deductible for a family?

The deductible on the Basic plan is $50 per person, $100 family deductible. The deductible for the Alternate plan is $25 per person, $75 family and the deductible only applies to class II and class III services.

Does the plan cover oral surgery?

Yes, the Basic plan would pay at 75% after the $50 deductible, and the Alternate plan would pay at 80% after the $25 deductible.

What about emergency care? Emergency out-of state coverage?

Emergency care is treated as preventative services and is covered at 75% on the Basic plan and 80% on the Alternate plan. For out of state emergencies, if the dentist is not a Aetna participating dentist, any benefit payment will be based on a prevailing fee; an amount established by the Aetna Dental Plan in the state in which the dental services are rendered. This will be paid directly to you. You are responsible for paying the dentist and filing your own claim.

Does the plan pay for sealants for children's' teeth?

Sealants are a benefit for persons through age 13, limited to permanent and first and second molar teeth free of cavities and restorations.

Does the plan cover whitening?

No, bleaching is an excluded service under this plan. However, you can use a medical reimbursement account to help pay for these expenses.

What is the maximum amount the plan pays?

The maximum the Basic plan will pay is $1,000.00 per person per fiscal year. The maximum the Alternate plan will pay is $2,000.00 per person per fiscal year.

Does the plan cover braces?

No, neither one of the dental plans covers orthodontics. However, you can use a medical reimbursement account to help pay for these expenses. See the information on reimbursement accounts.

What's the biggest difference between the basic and alternate plans?

The biggest difference between the plans is the Alternate plan will pay a maximum benefit up to $2,000 per fiscal year and the Basic plan will only pay a maximum benefit up to $1,000. The Alternate plan will cover diagnostic and preventative services at 100%, however the premium is higher than the Basic plan.