Healthy smile, healthy you
Healthy smile, healthy you
Aetna Dental? PPO plan
You can feel good about your dental care decisions with our dental preferred provider organization (PPO) plan.
Take advantage of: ? Great rates and no deductible ? Braces covered for adults, too ? Added perks -- like discounts on gym memberships,
massages, weight-loss programs and more
Your choice of any licensed dentist, anywhere You have the flexibility to visit dentists in or out of network. See if your dentist is in network at dentalb
Take control of your dental health and benefits using online tools to:
? Find a dentist based on dentist profiles, ratings, and patient reviews
? Compare actual out-of-pocket costs for many services, like a filling or X-ray, before visiting the dentist
? Schedule an appointment ? Provide feedback after your visit
Key benefits features
Yearly deductible
Yearly benefits maximum per member
Class A (preventive) services Like cleanings and X-rays
Class B (minor) services Like fillings and simple extractions
Class C (major) services Like crowns, root canals, dentures and implants
Class D (orthodontia) services -- braces Lifetime maximum per member: $2,000
In network $0 $30,000 Plan pays 100% NEW! Plan pays 70% Plan pays 40% Plan pays 50%
Out of network $0 $2,000 Plan pays 90%* Plan pays 60%* Plan pays 40%* Plan pays 50%*
Find out more at dental or call 1-877-459-6604.
*Out of network benefits are paid based on usual and prevailing charges or recognized charge levels, as determined by Aetna and specified in your plan documents.
19.03.329.1-FED J (9/19)
dental
Find your rating area by state/ZIP code (first three digits)
State
AK AL AL AR AZ CA CA CO CT CT DC DE FL FL GA GA HI IA ID IL IL IN IN KS KY
Rating
ZIP
area
entire state
5
356-358
1
rest of state
2
entire state
2
entire state
3
900-908, 910-931
3
rest of state
4
entire state
3
060-063
5
rest of state
3
entire state
2
entire state
2
330-334
2
rest of state
3
300-303, 305, 311, 399 3
rest of state
4
entire state
4
entire state
3
entire state
4
600-608
2
rest of state
3
460-464, 470, 472
2
rest of state
3
entire state
3
410, 452, 459
2
State KY LA MA MD ME MI MN MN MO MS MT NC ND NE NH NJ NJ NM NV NY NY NY
OH
OH
ZIP
rest of state entire state entire state entire state entire state entire state 550-555, 563 rest of state entire state entire state entire state entire state entire state entire state entire state 080-084 rest of state entire state entire state 005, 100-119, 124-126 063 rest of state
430-432, 440-443, 450-455
rest of state
Rating area 1 2 5 2 5 3 2 3 3 2 4 4 3 1 5 2 3 3 2 3 5 4
2
3
State ZIP
OK entire state
OR 970-973
OR rest of state
PA 153-154, 156, 160-162
PA 173-174, 189-196
PA rest of state
PR entire area
RI
entire state
SC entire state
SD entire state
TN entire state
TX entire state
UT entire state
VA 200-205, 220-227
VA rest of state
VT entire state
WA 986
WA rest of state
WI 540
WI rest of state
WV 254
WV rest of state
WY entire state
Guam all
International
Rating area
2 4 5 1 2 3 3 5 4 3 1 2 2 2 3 5 4 5 2 3 2 4 4 5 2
Plan rates (what you'll pay in 2020)
These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer which maintains your health benefits enrollment.
Rating area
Bi-weekly Self only
Bi-weekly Self + one
Bi-weekly Self + family
Monthly Self only
Monthly Self + one
Monthly Self + family
1
$16.03
$32.05
$48.08
$34.73
$69.44
$104.17
2
$17.65
$35.31
$52.95
$38.24
$76.51
$114.73
3
$18.79
$37.58
$56.35
$40.71
$81.42
$122.09
4
$20.73
$41.46
$62.19
$44.92
$89.83
$134.75
5
$22.52
$45.03
$67.54
$48.79
$97.57
$146.34
International $17.65
$35.31
$52.95
$38.24
$76.51
$114.73
Enroll at or call 1-877-888-3337.
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). Dental benefits are offered, underwritten and/or administered by Aetna Life Insurance Company (Aetna).
This is a brief description of the features of the Aetna Dental PPO plan. Before making a decision, please read the plan's applicable federal brochure(s). All benefits are subject to the definitions, limitations and exclusions set forth in the federal brochure. Discount offers provide access to discounted services and are not part of an insured plan or policy. Discount offers are rate-access offers and may be in addition to any plan benefits. The member is responsible for the full cost of the discounted services. Aetna may receive a percentage of the fee paid to a discount vendor. 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 dental.
?2019 Aetna Inc. 19.03.329.1-FED J (9/19)
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