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). Cigna DPPO networks offer convenient access to quality dentists all across the country and savings on covered dental services. ** Out-of-network benefits are paid based on recognized charge levels, as determined by Aetna and specified in your plan documents. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Select a state below to update coverage details. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. 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 This Agreement will terminate upon notice if you violate its terms. Aetna Dental has over 50 years of experience offering dental benefits. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts. With Aetna MA plans that include a direct member reimbursement (DMR) allowance, members are given a set amount of money to spend each year on dental care. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Orthodontic treatment except as covered in the Eligible Dental Services section of your insurance policy Some plans will cover around 50% of adult orthodontic treatment (including Invisalign), while others will only cover children up to 19 years old. 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. Applicable FARS/DFARS apply. California license number: OB84599. Get the Aetna Health app by texting GETAPP to 90156 for a link to download the app and create an account. Rendered before the effective date or after the termination of coverage, unless coverage is continued under the Special coverage options after your plan coverage ends section of your policy. Texas Members: In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). That are not medically necessary. Information is believed to be accurate as of the production date; however, it is subject to change. This benefit provides coverage of preventive and comprehensive dental services up to a benefit maximum and allows the member to choose any licensed dentist, in or out of network. Network dentists also file claims for you. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna Dental Direct PPO Plans are Subject to the Following Rules: Replacement Rule 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. Replacement of teeth beyond the normal complement of 32 A Nationwide Dental PPO Plan Who may enroll in this plan: All Federal employees, annuitants, and . You are leaving our Aetna Medicare website and going to an Aetna Medicaid website. In case of a conflict between your plan documents and this information, the plan documents will govern. You get a broad choice of dentists and dental providers, wellness discounts and offers that stretch your health care dollar, digital tools to easily manage your care, and more. Aetna Inc. and its subsidiary 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. 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 Why choose ${company} Medicare Solutions? You can choose from thousands of dental providers nationwide, including those who offer virtual dental visits. All three plans are available in all 50 states and D.C and feature increased formulary coverage from 2022. Applicable FARS/DFARS apply. 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. . That are cosmetic in nature. However, if you do this, you wont benefit from negotiated rates. Dental benefits are already included inthe majority ofAetna MA plans. For work that began before you were covered under the plan, The following dental services and supplies. For additional language assistance: Choose from more than 120,000 dental providers nationwide, including providers who offer virtual visits through tele-dentistry. This Aetna Dental Preferred Provider Organization (PPO) benefits summary is provided by Aetna Life Insurance Company for some of the more frequently performed dental procedures. Privacy policy: Aetna.com/legal-notices/privacy.html. In Pennsylvania, the waiting period is called an elimination period and most Basic services have one month waiting period. Password * Forgot Password? Please be sure to add a 1 before your mobile number, ex: 19876543210, Use our provider search tool to search, in the network, by name, specialty or procedure, See your benefits summary and get information about what's covered, Pull up your ID card whenever you need it. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Digital tools to easily manage your care and access your ID card whenever needed. Check with your plan for more details. It gives members access to discounted fees according to schedules negotiated with providers by Aetna Life Insurance Company for Aetna Vital Savings. A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl. Network dentists offer special rates for covered services. 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. Members should discuss any matters related to their coverage or condition with their treating provider. Language services can be provided by calling the number on your member ID card. Aetna dental plans are not considered to be qualified health plans under the Affordable Care Act. Some plans cover comprehensive services. Find the right plans and programs for you. 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. For language services, please call the number on your member ID card and request an operator. No fee schedules, basic unit, relative values or related listings are included in CPT. Member Services: 1-877-238-6200 Caring for your teeth should never feel out of reach with Aetna Dental Direct. 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. 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. Aetna MA plans offer three types of dental coverage: For HMO plans, you must see a dental care provider within the network of approved providers. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Aetna Student HealthSM is the brand name for products and services provided by Aetna Life Insurance Company, Aetna Health and Life Insurance Company and their affiliated companies. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. The AMA is a third party beneficiary to this Agreement. Aetna Dental Direct insurance plan is offered by Aetna Life Insurance Company (Aetna). 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. Please log in to your secure account to get what you need. 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. Aetna Medicare Advantage HMO-POS plans. Tooth Missing But Not Replaced Rule Each main plan type has more than one subtype. Register to watch this video opens in a new tab to get answers to frequently asked questions about the Verizon Advantage plan. How is coverage handled overseas? 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 information programs provide general dental information and are not a substitute for diagnosis or treatment by a dentist or other health care professional. All services deemed "never effective" are excluded from coverage. Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. Print and fill out the reimbursement form. 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. License to use 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. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. And one of the main perks of joiningaMedicare Advantage (MA)planis that many plans offer dental coverage to helpyoukeep upwithyour oral health. See your Evidence of Coverage for details. 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. Go to the American Medical Association Web site. For additional language assistance: Espaol | | Ting Vit | | Tagalog | P | | Kreyl | Franais | Polski | Portugus | Italiano | Deutsch | | | Other Languages. Very low rates. Selection of a program provider is also the responsibility of the participant and is not based on any representations by Aetna. Disclaimer of Warranties and Liabilities. If you have more questions, just call us at 1-866-241-0356 (TTY: 711), Monday through Friday, 8 AM to 9 PM ET. Whether youre at your desk or on the go, our easy-to-use digital tools help you manage your dental plan, save money and make smart decisions about your care. The amount of the discounts will vary depending on the provider and type of service or supply received. No fee schedules, basic unit, relative values or related listings are included in CPT. 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. *Actual costs and savings vary by provider and geographic area. are covered at 100% on most plans. While we encourage you to submit all claims electronically, if you need to submit a paper claim, Review our paper claim Tips. Not available in many states. 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. Applicable FARS/DFARS apply. 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. Program providers are solely responsible for the products and services they provide. Links to various non-Aetna sites are provided for your convenience only. Since there is no paperwork or reimbursement, you must pay for the service at the time its provided. The following information is about the Aetna Medicare Choice Plan (PPO) formulary (or drug list). ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Others have four tiers, three tiers or two tiers. Treating providers are solely responsible for medical advice and treatment of members. The Aetna HealthSM app and your Aetna member website are personalized, seamless and easy to use. The material is for information only. For example, you pay 20%, and your plan pays 80%. 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. Please call them at the number on your member ID Card or at 877-480-4161 from 8:30 a.m.-5:30 p.m, Mon-Fri. Crown, inlays and onlays, and veneers unless for one of the following: Enrollment in our plans depends on contract renewal. Premium deductions will start with the first full pay period Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Medicare coverage for the whole you body, mind and spirit, Discover coverage that takes a total approach to health, See how we help you get the right resources and care, Take full advantage of everything your plan offers you. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. 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. Your benefits plan determines coverage. Just check with your employer to see which plans are available to you. The ABA Medical Necessity Guidedoes not constitute medical advice. 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). Members must make payments directly to the providers in the Aetna Vital Savings program. All Rights Reserved. The member's benefit plan determines coverage. * In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). 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. Dental services and supplies made with high noble metals (gold or titanium) except as covered in the Eligible Dental Services section of your insurance policy Taking care of your teeth is as an important part of taking care of your health. 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. A primary care dentist (PCD) helps guide your care with this DMO* plan. If you do not intend to leave our site, close this message. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Cons. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Do you cover implants? App Store is a service mark of Apple Inc. Android and Google Play are trademarks of Google LLC. The Appointment of Representative form is on CMS.gov. your coverage will begin on January 1, 2022. We're here 8 a.m. - 8 p.m., Monday through Friday. This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract. Links to various non-Aetna sites are provided for your convenience only. See dentists both in and out of our network. The change will start the first day of the next month. All services deemed "never effective" are excluded from coverage. The SBC shows you how you and the plan would share the cost for covered health care services. Please log in to your secure account to get what you need. Go to the American Medical Association Web site.