aetna dental ppo coverage 2022
Aetna Dental Direct PPO Plans are Subject to the Following Rules: Replacement Rule When billing, you must use the most appropriate code as of the effective date of the submission. The following information is about the Aetna Medicare Choice Plan (PPO) formulary (or drug list). That are not medically necessary. Learn about Medicare Advantage It is not available in Montana, Vermont or Tennessee. CPT is a registered trademark of the American Medical Association. 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. 2022 - 2023 Aetna PPO Dental Plan Design and Benefits Summary. Do you want to continue? Print dental claim form (English) * In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-877-698-4825, is the Discount Medical Plan Organization. Services and supplies provided where there is no evidence of pathology, dysfunction or disease, other than covered preventive services Dental plans are all different. Member Services: 1-877-238-6200 Do you cover adult orthodontia? Annual Deductible $50 Per Person $150 Per Family, per calendar year, Annual Maximum Benefit $1,250 per covered person. New and revised codes are added to the CPBs as they are updated. You can choose from one of the more than 420,000 dentist locations in the Aetna Dental PPO network. Why choose ${company} Medicare Solutions? Applicable FARS/DFARS apply. Treating providers are solely responsible for medical advice and treatment of members. Preventive services Waiting period*: None, Basic services are covered at 80% with in-network providers (after deductible), Major services are covered at 50% with in-network providers (after deductible), Waiting periods for basic and major care waived with prior dental insurance, No waiting periods for preventive services, See any dentist, but youll save more if you stay in network, 100% coverage for preventive services when you see an in-network dentist, Basic services covered at 80% with in-network providers (after deductible), Major services covered at 50% with in-network providers (after deductible), Waiting periods* for Basic and Major services waived with prior dental insurance, $50 individual / $150 family per calendar year, Waiting period is waived if all family members enrolling had dental coverage within the past 90 days. Links to various non-Aetna sites are provided for your convenience only. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. The plan offers preventive treatment at 100% with no out of pocket cost. Certain preventive care services are covered at little-to-no-extra cost 2 when . Direct member reimbursement allowance: How to get reimbursed for dental care. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. 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. 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). This is only a summary of the plan's exclusions and limitations. You may also have to file your own claims. 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. Treating providers are solely responsible for medical advice and treatment of members. 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. Texas Members: In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). For someAetna MA plansthatdontincludedental coverage, you mayhave the choiceof payingextra each month for dental benefits. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. No deductible, no claims forms and no yearly dollar limits. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. 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). LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). This material is for information only. Please be sure to add a 1 before your mobile number, ex: 19876543210. Visit a dentist in the Aetna Dental PPO* network. Some subtypes have five tiers of coverage. 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). Coverage for the first installation of removable dentures; fixed bridgework and other prosthetic services is subject to the requirements that such removable dentures, fixed bridgework and other prosthetic services are: needed to replace one or more natural teeth that were removed while this policy was in force for the covered person; and are not abutments to a partial denture; removable bridge; or fixed bridge installed during the prior 8 years. Copyright 2015 by the American Society of Addiction Medicine. This is the total amount per person your plan will pay toward the in-network cost of dental care each year. You may also be required to pay a portion of the costs. View your plan details. Original Medicare, on the other hand, does not coverroutinedental care, such as cleanings, X-rays,andfillings. This may be a copay, which is a set dollar amount. Your benefits plan determines coverage. So your share of the cost is usually lower. 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. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. Be sure to make copies of all of your paperwork. Aetna may receive a percentage of the fee you pay to the discount vendor. Rates start at $7.99 a month. Your dental plan may have yearly and lifetime limits on coverage. Some of the covered dental services may include (be sure to check with your plan for details): If you have network or OSB coverage, you may be limited to a specific number of services per year. 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. Tooth Missing But Not Replaced Rule Instruction for diet, plaque control and oral hygiene And you don't have to have Aetna medical or other coverage with us to purchase. Allow approximately 4-6 weeks for reimbursement. Coinsurance: the percentage of dental care expenses you pay after your deductible. 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. 4. . Language services can be provided by calling the number on your member ID card. 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. Accessibility Services:If you are a person with a disability who needs assistance using our websites, our Customer Service Representatives can assist you. If you do not intend to leave our site, close this message. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. We make dental care convenient. Whats covered under Medicare Advantage dental plans. One thing to keep in mind as you plan for dental care with this plan is that the cost of certain dental procedures and services can vary according to each provider. Language services can be provided by calling the number on your member ID card. Aetna dental insurance comes with stand-alone dental coverage or dental, vision, and hearing coverage. To check that your provider participates, visit our website or call us. Copyright 2015 by the American Society of Addiction Medicine. 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. Choose from leading manufacturers and get free follow-up service for one year. CPT only Copyright 2022 American Medical Association. 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. Orthodontic treatment except as covered in the Eligible Dental Services section of your insurance policy Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. You can start using your plan right away! Some plans will cover around 50% of adult orthodontic treatment (including Invisalign), while others will only cover children up to 19 years old. Covered family members can choose their own PCDs. Members must make payments directly to the providers in the Aetna Vital Savings program. No fee schedules, basic unit, relative values or related listings are included in CPT. Youll need to select a primary care dentist in the DMO network. It gives members access to discounted fees according to schedules negotiated with providers by Aetna Life Insurance Company for Aetna Vital Savings. If you have more questions, just call us at 1-866-241-0356 (TTY: 711), Monday through Friday, 8 AM to 9 PM ET. The Aetna Dental Direct plan covers preventative care 100% with no out of pocket cost. Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. With Aetna Dental Direct, youll get the coverage you need to keep your teeth healthy. Deductible and annual maximum amounts cross-apply between in network and out of network. SBBC now offers the option of four dental plans available from three dental carriers. Very low rates. Cigna DPPO networks offer convenient access to quality dentists all across the country and savings on covered dental services. 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). The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Once youre a member, heres how you can connect: 1. 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. If you do not intend to leave our site, close this message. 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 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 Dental care is a vital part of maintaining yourhealth and well-being, especially as you age. Once youre a member, you have two ways to engage with your plan online. - The tooth is an abutment to a covered partial denture or fixed bridge. You are now being directed to the CVS Health site. A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl. The availability of a particular provider cannot be guaranteed and provider network composition is subject to change. The plan offers preventive treatment at 100% with no out of pocket cost. Enrollment in our plans depends on contract renewal. Persons with a hearing or speech disability can use 711 for Telecommunications Relay Service (TRS). App Store is a service mark of Apple Inc. Android and Google Play are trademarks of Google LLC. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. To learn more about using your Aetna MA dental benefits, read our guide below. 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. 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. For additional language assistance: Espaol | | Ting Vit | | Tagalog | P | | Kreyl | Franais | Polski | Portugus | Italiano | Deutsch | | | Other Languages. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". 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. Our plan selection pages will be down for maintenance starting Friday, April 16, at 9 p.m. and returning by 1 p.m. Saturday, April 17. Thats it. The member's benefit plan determines coverage. 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. Selection of a program provider is also the responsibility of the participant and is not based on any representations by Aetna. Replacement of teeth beyond the normal complement of 32 How is coverage handled overseas? Note not all plans and offers available in all markets. You can also download it from the App Store or the Google PlayTM store. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Information is believed to be accurate as of the production date; however, it is subject to change. 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 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. 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. Aetna Student Health Agency Inc. is a duly licensed broker for student accident and health insurance in the Commonwealth of Massachusetts. Want to see options for a different location? DISCOUNT OFFERS ARE NOT INSURANCE. PLAN EXCLUSIONS AND LIMITATIONS* 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. 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. In Pennsylvania, the waiting period is called an elimination period and most Basic services have one month waiting period. Im turning 65 or just starting to explore Medicare. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Print and fill out the reimbursement form. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. 2023 DentalPlans.com, Inc. All Rights Reserved. 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. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Visit a dentist in the Aetna Dental PPO* network. Send the form with the receipt to the claims address found on your member ID card. Aetna will expand the Total Choice dental benefit introduced in 2022 to additional Individual MA HMO-POS and PPO plans. For more details see our Privacy Policy. . 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. 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. This Agreement will terminate upon notice if you violate its terms. Information is believed to be accurate as of the production date; however, it is subject to change. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Network dentists offer special rates for covered services. Aetna Invisalign Coverage Your Aetna plan might cover your Invisalign treatment, although it depends entirely on the plan. 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. With Aetna Dental Direct, you'll get the coverage you need to keep your teeth healthy. 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. 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) With our HMO-POS plans, you can enjoy all the benefits of receiving medical care through a network provider. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. These dental benefits follow the same structure as network plans and may require you to choose a dental provider within your network. This information is neither an offer of coverage nor medical advice. Password * Forgot Password? With adirect member reimbursementallowance, youre givena set amount of money to spend each year on dental care.. Massachusetts license number: 10041444. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Student health insurance plans are underwritten by Aetna Life Insurance Company (Aetna). Each main plan type has more than one subtype. Click the Register button to get started. 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. Premium deductions will start with the first full pay period Aetna dental plans are not considered to be qualified health plans under the Affordable Care Act. The dental discounts are available through participating healthcare providers only. Surgical removal of impacted wisdom teeth when only for orthodontic reasons 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 Aetna Vital Savings discount program is not insurance. Yes, I'm a memberNo, I'm looking for a plan. The ABA Medical Necessity Guidedoes not constitute medical advice. To view the form just select Continue. 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. Aetna handles premium payments throughInstaMed, a trusted payment service. 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. Aetna is continuing to expand the Aetna Dental PPO network across the country to . Aetna Dental Direct | Secure Member Portal Login Secure Member Portal * required Username * Forgot Username? Get lower rates when you go to a dentist thats in your PPO network. 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). As you age, maintaining your oral health is an important part of your whole-body wellness. All Rights Reserved. In case of a conflict between your plan documents and this information, the plan documents will govern. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. Check your plan's Evidence of Coverage. 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. General anesthesia and intravenous sedation, unless specifically covered and only when done in connection with another eligible dental service your primary care dentist will refer you to one in our network. If you do not intend to leave the Medicare site, close this message. Aetna Dental has over 60 years of experience offering dental benefits. Plan 41 Effective Date: 01-01-2022 Hampshire, Middlesex, Norfolk, Plymouth, Suffolk and Worcester. 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. Aetna Dental Direct insurance plan is offered by Aetna Life Insurance Company (Aetna). That are provided by a family member. You can choose from one of the more than 420,000* dental providers nationwide. 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. Participating dentists have agreed to provide services at a negotiated rate for covered services. Get the coverage you need to keep your mouth, teeth and gums healthy. 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. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members.
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