**Through the ChooseHealthy program, which is provided by ChooseHealthy, Inc., a subsidiary of American Specialty Health Incorporated (ASH). Treating providers are solely responsible for medical advice and treatment of members. Go to the American Medical Association Web site. This is donethrough an optional supplemental benefit. 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. Links to various non-Aetna sites are provided for your convenience only. CPT only copyright 2015 American Medical Association. Reprinted with permission. This information is neither an offer of coverage nor medical advice. Accessibility Services:If you are a person with a disability who needs assistance using our websites, our Customer Service Representatives can assist you. Get coverage to any doctor (in or out-of-network) at the same member cost share. Special perks and discounts, including exclusive offers from CVS Health, Search for providers in-network by using our. 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. Alternate Treatment Rule The Aetna Dental Direct plan covers preventative care 100% with no out of pocket cost. Check your plan's Evidence of Coverage. 151 Farmington Avenue, Hartford, CT 06156. The ABA Medical Necessity Guidedoes not constitute medical advice. 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. PDF A Nationwide Dental PPO Plan - BENEFEDS Brushing, flossing and getting regular dental checkups help to keep your mouth healthy. With Aetna Vital Savings, you can choose from more than 250,0001 available dental practices across the country. Caring for your teeth should never feel out of reach with Aetna Dental Direct. Annual Deductible $50 Per Person $150 Per Family, per calendar year, Annual Maximum Benefit $1,250 per covered person. 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. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. AetnaDentalOffers.com is brought to you by DentalPlans.com. A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl. 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. Weve broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. Note not all Aetna dental plans and offers available in all markets. Find your dentist now in Aetna's large nationwide network. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Pay less for acupuncture,* chiropractic visits, therapeutic massage and nutrition services** and for products like wearable fitness devices and fitness kits. . *Actual costs and savings vary by provider and geographic area. 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. 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. Save on gym memberships, health coaching, fitness gear, wearable fitness devices, group fitness on demand and more. CPT only Copyright 2022 American Medical Association. 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. Learn more and see if your dentist is in the network with these plans on aetna.com. How is coverage handled overseas? Im turning 65 or just starting to explore Medicare. Since there is no paperwork or reimbursement, you must pay for the service at the time its provided. 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. Youre given an annual allowance to spend on dental care. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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. Member Services: 1-877-238-6200 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 2022 - 2023 Aetna PPO Dental Plan Design and Benefits Summary. 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. Your dental plan may have yearly and lifetime limits on coverage. Legal notices 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). The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Please log in to your secure account to get what you need. 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. And withAetna MA plans, you have a variety of options to make it more affordable and easierto keep up withyourdental care. You can choose from one of the more than 420,000 dentist locations in the Aetna Dental PPO network. 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. For PPO plans and most HMO-POS plans, you have the option to go to any licensed provider, but could save money by using a provider in the network. Register Each main plan type has more than one subtype. 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. 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. 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. Texas Members: In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). Choose a PCD from our network**: Use ourprovider search toolto find one. Cancelled or missed appointment charges or charges to complete claim forms. You also have the flexibility to visit a licensed dentist who does not participate in our network. Aetna Dental Direct Preferred PPO Plan | DentalPlans.com CPT is a registered trademark of the American Medical Association. With Aetna Dental Direct, youll get the coverage you need to keep your teeth healthy. All Rights Reserved. As of April 4, 2022, Medicare covers up to eight over-the-counter COVID-19 tests each month, at no extra cost to you if you have . 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. How to enroll: This Agreement will terminate upon notice if you violate its terms. 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. Section 5 Dental Services and Supplies Class A Basic 16 . Aetna handles premium payments through Payer Express, a trusted payment service. When billing, you must use the most appropriate code as of the effective date of the submission. Applicable FARS/DFARS apply. Aetna offers two Dental PPO insurance plans to individuals and families, the Aetna Dental Direct Preferred and the Aetna Dental Direct Core. Original Medicare, on the other hand, does not coverroutinedental care, such as cleanings, X-rays,andfillings. 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. If your MA plan doesnt include dental coverage, or you want to increase your coverage, you may have the option to purchase dental benefits for an additional monthly premium. For more details see our Privacy Policy. Others have four tiers, three tiers or two tiers. Language services can be provided by calling the number on your member ID card. 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. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). With a PPO plan, you can visit any dentist you want (whether they are in or out of the network) and usually receive some coverage level. Visit the secure website, available through www.aetna.com, for more information. View Medicare Coverage & Benefits | Aetna Medicare See your PCD for regular exams and to get referrals if you need specialty care. Direct member reimbursement allowance: How to get reimbursed for dental care. Premium deductions will start with the first full pay period Temporomandibular joint dysfunction/disorder. We've broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. 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. Unlisted, unspecified and nonspecific codes should be avoided. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. If you enroll in an Aetna Medicare Advantage plan that includes dental coverage, some of the services that may be covered include: Teeth cleaning, scaling and polishing Office visits for oral examinations Non-surgical extractions Fillings Minor denture adjustments X-rays Oral hygiene instruction Dietary advice and counseling Minor bite adjustments Aetna Dental Direct Preferred PPO - Aetna Dental Plans The information you will be accessing is provided by another organization or vendor. By submitting your information you are agreeing to receive communications from Aetna Dental Offers. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Top 3 reasons to choose Aetna Dental 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. All care is the responsibility of the treating provider, in consultation with the participant. You get access to discounts off the regular charge on products and services offered by third-party vendors and providers. Aetna handles premium payments through InstaMed, a trusted payment service. Aetna Medicare is a HMO, PPO plan with a Medicare contract. Program providers are solely responsible for the products and services they provide. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. your coverage will begin on January 1, 2022. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Aetna makes no payment to the third parties you are responsible for the full cost. 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. The plan offers both network (DMO) or out-of-network (PPO) coverage. Dental insurance plans are underwritten by Aetna Life Insurance Company. Certain preventive care services are covered at little-to-no-extra cost 2 when . 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. 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. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). View your plan - Verizon - Aetna Medicare Advantage The SBC shows you how you and the plan would share the cost for covered health care services. What's an Evidence of Coverage (EOC)? | Aetna Medicare Disclaimer of Warranties and Liabilities. Provider Directory Last Updated: April 22, 2023 Page Last Updated: January 27, 2023 PDF Summary of Benefits and Coverage: What this Plan Covers - Aetna Feds For example, you pay 20%, and your plan pays 80%. 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 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 plans are all different. All Rights Reserved. *Acupuncture is an essential health benefit, and the discount for this service may duplicate benefits if you are enrolled in a full-service plan. Language services can be provided by calling the number on your member ID card. Services and supplies provided where there is no evidence of pathology, dysfunction or disease, other than covered preventive services Aetna Student Health is offering a Dental Preferred Provider Organization (PPO) planto Columbia University students and their eligible dependents. Links to various non-Aetna sites are provided for your convenience only. 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. Some subtypes have five tiers of coverage. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Benefits / Dental - browardschools.com Applicable FARS/DFARS apply. - The tooth is an abutment to a covered partial denture or fixed bridge. Preferred Provider Organization (PPO) plans. Pricing starts at $20 in most regions, and also includes: No waiting periods Inclusive plans. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Aetna Dental Direct insurance plan is offered by Aetna Life Insurance Company (Aetna). Get a discount on blood pressure montiors, pedometers, activity trackers, pain relief devices and other Omron products. It's generally available starting in September and describes costs and benefits of your plan that will take effect on January 1 of the following year. Do you cover adult orthodontia? If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Persons with a hearing or speech disability can use 711 for Telecommunications Relay Service (TRS). 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. 2022 . Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Rates start at $7.99 a month. However, if you do this, you wont benefit from negotiated rates. Surgical removal of impacted wisdom teeth when only for orthodontic reasons For language services, please call the number on your member ID card and request an operator. Check your benefits summary, so youll know what to pay. Youcansee anylicenseddental provider in the U.S. You can use the allowance toward almost all dental services except for teeth whitening and a few administrative costs (e.g., missed appointments). Aetna 2023 Medicare plans put money back in members' pockets No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Some subtypes have five tiers of coverage. 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 The Appointment of Representative form is on CMS.gov. Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. 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) Claim Submission Tips & Guidelines | Aetna Dental Privacy policy: Aetna.com/legal-notices/privacy.html. Youll pay for your dental care up front when you see a dentist, and then submit your receipts to Aetna for reimbursement. 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. Aetna Dental Insurance - Prince George's County Public Schools 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. Disclaimer of Warranties and Liabilities. This material is for information only. This site has its own log in. Information is believed to be accurate as of the production date; however, it is subject to change. No deductible, no claims forms and no yearly dollar limits. 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 school has chosen a plan that makes it easy to keep your smile. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Aetna Medicare Dental Provider Results - sslws.net You are now being directed to the CVS Health site. Aetna Dental Insurance Plans for Seniors in 2023 - The Senior List 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. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. For more information, please call HSA Consulting Customer Service at (888) 978-8355. You can change your PCD once a month on your member website. Aetna Medicare Advantage HMO-POS plans. It does not meet the Minimum Creditable Coverage requirements in Massachusetts. The Aetna HealthSM app and your Aetna member website are personalized, seamless and easy to use. Check your Evidence of Coverage (EOC) for more details. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. To learn more about using your Aetna MA dental benefits, read our guide below. Treating providers are solely responsible for medical advice and treatment of members. 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. These typically include some level of dental coverage, including twice-yearly oral health exams, teeth. **Out-of-network benefits vary by state and are subject to certain charge limits. 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. This Agreement will terminate upon notice if you violate its terms. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Best Dental Insurance in 2023 Compare Plans & Pricing 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. Why choose ${company} Medicare Solutions? Does your dental plan have a missing tooth clause? Dental benefits are already included inthe majority ofAetna MA plans. You can find a network provider by logging in as a member and going to our provider directory. 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 Contact Us | Aetna Dental Plans See your Evidence of Coverage for details. Acupuncture, acupressure and acupuncture therapy Visit any licensed dentist outside the network. Aetna is continuing to expand the Aetna Dental PPO network across the country to . You are leaving our Medicare website and going to our non-Medicare website. So, you wont see cost information here. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Give your member information at your visit. Get savings on weight-loss programs and meal plans, and enjoy one-on-one help, personalized menus, online tools and chat rooms. Visit a dentist in the Aetna Dental PPO* network. As you plan for your dental care, keep in mind that you may have limits on the amount of preventive care visits you can make each year, as well as caps on coverage for comprehensive services. 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. 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). Find a Medicare Dentist | Aetna Medicare 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. Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. The information you will be accessing is provided by another organization or vendor. 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. Does Aetna Medicare Cover Dental? 2022-2023 Coverage Explained The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. Knowing more about your plan can help you get the most from your benefits and covered services.
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