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. With adirect member reimbursementallowance, youre givena set amount of money to spend each year on dental care.. Once youre a member, you have two ways to engage with your plan online. Deductible: the dollar amount some plans require you to pay for services before coverage starts. Applicable FARS/DFARS apply. So your share of the cost is usually lower. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. 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. Choose a PCD from our network**: Use ourprovider search toolto find one. 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. Your dental plan pays the rest. First installation of a denture or fixed bridge, and any inlay and crown that serves as an abutment to replace congenitally missing teeth or to replace teeth all of which were lost while the person was not covered A Nationwide Dental PPO Plan Who may enroll in this plan: All Federal employees, annuitants, and . In case of a conflict between your plan documents and this information, the plan documents will govern. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Certain preventive care services are covered at little-to-no-extra cost 2 when . Caremark.com is the secure website where Aetna Medicare SilverScript members can manage prescriptions, sign up for mail delivery, view order status, find drug pricing, and identify savings options. All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. They are not benefits under your insurance plan. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Reprinted with permission. - The tooth is an abutment to a covered partial denture or fixed bridge. your primary care dentist will refer you to one in our network. 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. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. This Agreement will terminate upon notice if you violate its terms. It's generally known as the Evidence of Coverage (EOC). Your benefits plan determines coverage. For language services, please call the number on your member ID card and request an operator. For more information, please call HSA Consulting Customer Service at (888) 978-8355. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. If you have more questions, just call us at 1-866-241-0356 (TTY: 711), Monday through Friday, 8 AM to 9 PM ET. Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. You can change your PCD once a month on your member website. Please consult with the respective plan detail page for additional plan terms. **Out-of-network benefits vary by state and are subject to certain charge limits. Since Clinical Policy Bulletins (CPBs) 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. CPT is a registered trademark of the American Medical Association. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Aetna may receive a percentage of the fee you pay to the discount vendor. While we encourage you to submit all claims electronically, if you need to submit a paper claim, Review our paper claim Tips. 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. ${tty} to chat about any Medicare questions you have. 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. Get discounts on oral health care products like Z Sonic toothbrushes, replacement brush heads and various oral health care kits. Copyright 2015 by the American Society of Addiction Medicine. 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). Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Spirit Dental & Vision is a nationwide carrier that offers a range of PPO dental insurance plan. 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 Some plans exclude coverage for services or supplies that Aetna considers medically necessary. You are leaving our Medicare website and going to our non-Medicare website. 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). For additional language assistance: Espaol | | Ting Vit | | Tagalog | P | | Kreyl | Franais | Polski | Portugus | Italiano | Deutsch | | | Other Languages. Treating providers are solely responsible for medical advice and treatment of members. 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. When you have an Aetna Dental plan, you know youre taking the right steps toward being healthy. 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 Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Aetna Student Health Agency Inc. is a duly licensed broker for student accident and health insurance in the Commonwealth of Massachusetts. Select a state below to update coverage details. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). For example, you pay 20%, and your plan pays 80%. THIS IS A SUMMARY ONLY AND DOES Aetna Health members, log-in securely to your account to access all of your health and benefits information, or get your user name and/or password if you've forgotten it. Remember Username Secure Login First time here? . Dental benefits and dental insurance plans contain exclusions and limitations. Please be sure to add a 1 before your mobile number, ex: 19876543210. We make dental care convenient. Be sure to make copies of all of your paperwork. Dental information programs provide general dental information and are not a substitute for diagnosis or treatment by a dentist or other health care professional. 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. Register to watch this video opens in a new tab to get answers to frequently asked questions about the Verizon Advantage plan. Not available in many states. 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). Do you want to continue? This search will use the five-tier subtype. For more details see our Privacy Policy. CPT only copyright 2015 American Medical Association. 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*. 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. If you do not intend to leave our site, close this message. The change will start the first day of the next month. The member's benefit plan determines coverage. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 5. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Treating providers are solely responsible for medical advice and treatment of members. 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. You will receive the discount off the providers usual and customary fees when you pay. 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. 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. Aetna Dental Direct insurance plan is offered by Aetna Life Insurance Company (Aetna). - It is treatment for decay or traumatic injury and teeth cannot be restored with a filling material And withAetna MA plans, you have a variety of options to make it more affordable and easierto keep up withyourdental care. 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. 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. ZIP CODE View 2023 plans Learn about these benefits Dental, eyewear and hearing coverage is available. Applicable FARS/DFARS apply. Persons with a hearing or speech disability can use 711 for Telecommunications Relay Service (TRS). For work-related conditions. To check that your provider participates, visit our website or call us. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 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. That are cosmetic in nature. 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. Enrollment in our plans depends on contract renewal. You can choose from one of the more than 420,000* dental providers nationwide. However, if you do this, you wont benefit from negotiated rates. The Aetna Dental Direct plan covers preventative care 100% with no out of pocket cost. 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. Deductible applies to basic and major services only. 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 Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. What does the Aetna Dental PPO Plan cover? 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. That would not be made if you did not have coverage. The Aetna HealthSM app and your Aetna member website are personalized, seamless and easy to use. Studies show that a healthy mouth helps you avoid health problems in the body, too. FEDVIP Program Highlights A Choice of Plans and . 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. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Aetna will continue to offer most Medicare Advantage members access to routine vision, dental and hearing coverage. your coverage will begin on January 1, 2022. 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. 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. The information you will be accessing is provided by another organization or vendor. The plan offers preventive treatment at 100% with no out of pocket cost. In excess of the benefit, dollar, day, visit, or supply limits stated in your schedule of benefits. Provided by an out-of-network provider in excess of the recognized charge. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. **Through the ChooseHealthy program, which is provided by ChooseHealthy, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Disclaimer of Warranties and Liabilities. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Learn more about our network and DMR plans Search other providers Need a provider directory? 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. We encourage you to check with your participating provider prior to beginning treatment. Save on popular designer frames*** and vision items that dont need a prescription. You can visit national chains and thousands of doctors in private practice. There are no claims or referrals to worry about, and no limits on how much you can save. 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. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Replacement of teeth beyond the normal complement of 32 In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Visit a dentist in the Aetna Dental PPO* network. Others have four tiers, three tiers or two tiers. To learn more about using your Aetna MA dental benefits, read our guide below. You can choose from thousands of dental providers nationwide, including those who offer virtual dental visits. Pros. AetnaDentalOffers.com is brought to you by DentalPlans.com. Links to various non-Aetna sites are provided for your convenience only. Covered family members can choose their own PCDs. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-877-698-4825, is the Discount Medical Plan Organization. Yes, I'm a memberNo, I'm looking for a plan. Aetna Dental Direct | Secure Member Portal Login Secure Member Portal * required Username * Forgot Username? With Medicare Advantage plans that include a network dental benefit, youre covered up front for specified dental services but may be required to see a dentist within your network of providers. The AMA is a third party beneficiary to this Agreement. Purchasing the Aetna dental discount cards is easy - online, by mail or by phone. App Store is a service mark of Apple Inc. Android and Google Play are trademarks of Google LLC. With Aetna Vital Savings, you can choose from more than 250,0001 available dental practices across the country. When billing, you must use the most appropriate code as of the effective date of the submission. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. Aetna Dental Savings Plans are NOT dental insurance and the dental savings will vary by provider, plan and zip code. All services deemed "never effective" are excluded from coverage. The Aetna Vital Savings discount program is not insurance. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. CPT is a registered trademark of the American Medical Association.
