Choose a Denali PPO Network Dental plan and save on out-of-pocket costs when visiting an in-network provider. Pay less for in-network services – the percentage you pay is based on a discounted rate.
This Dental Insurance Plan helps you cover the costs of dental care. Covered dental services include exams, cleanings, fillings and extractions, as well as crowns, bridges and dentures. This policy pays you for covered dental expenses based upon the reimbursement schedule of the PPO network fees for those covered expenses after the $100 lifetime deductible has been satisfied.
These percentages are: 100% for Preventive Services, 40% for Diagnostic Services, 20% for Basic & Major and 10% for Child Orthodontia Services in the 1st year. In the 2nd year of coverage, Diagnostic Services increase to 80%, Basic & Major Services increase to 50% and Child Orthodontia increases to 25%. In the 3rd year Diagnostic Services increase to 90%, Basic and Major increase to 60% and Child Orthodontia increases to 50%.
Calendar Year Maximum - $1,500, $2,500 or $3,500 per insured
Lifetime Deductible - $100 per person/ $300 per family
Dental expenses are paid based on a percentage of Reasonable and Customary (R&C) fees. This means the most common charge for similar professional services, drugs, procedures, devices, supplies or treatment within the Geographic Area in which the charge is incurred. The most common charge means the lesser of:
• The actual amount charged by the provider;
• The negotiated rate;
• The usual charge which would have been made by a provider (Dentist, Hospital, etc) for the same or a comparable professional services, drugs, procedures, devices, supplies or treatment within the same Geographic Area, as determined by Us.
"Geographic Area" means the three digit zip code in which the service, treatment, procedure, drugs or supplies are provided; or a greater area if necessary to obtain a representative cross-section of charge for a like treatment, service, procedure, device drug or supply.
With nearly 112,000 providers the Aetna Dental Access PPO Network provides our clients with plenty of choice and quality.
(Not available in AK, FL, ID, IN, ME, NH, NC, PA, WA and WY.)
*Dental counts as of February 2012, Aetna Enterprise Provide Database
Aetna is a brand name used for product and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates. The Aetna Dental Administrators program is powered by the Aetna Dental Access® network. This material is for information only. Information is believed to be accurate as of the product date; however, it is subject to change.
More than 151,000 Dentist access points.
(Only available in AK, FL, ID, IN, ME, NH, NC, PA, WA and WY.)