This benefits summary of the Aetna Dental DMO (Dental Maintenance Organization) provides information on benefits provided when services are rendered by a participating dentist. None. Those for any of the following services (Does not apply to the DMO plan in TX): (a) an appliance or modification of one if an impression for it was made before the person became a covered . Those for dentures, crowns, inlays, onlays, bridgework, or other appliances or services used for the purpose of splinting, to . Aetna Dental Maintenance Organization (DMO) A DMO is a network of dentists and specialists who provide dental care services at a fixed cost. New Plan Selections effective January 1, 2022 (for information on 2021 plans, contact Nancy Signore) Open Enrollment period is October 27, 2021 through November 17, 2021 for . Search: Aetna Dmo Network. Original Medicare, on the other hand, does not cover routine dental care, such as cleanings, X-rays . Dental . DMO Dental - New Jersey Specialty Care Dental Schedule of Benefits. You have a choice of two Aetna dental plans Illinois DMO is not an HMO Your DMO benefits and insurance plan begins with your primary care dentist (PCD) , Aetna Health of California Inc See this summary chart on how our two dental plans; the Aetna Dental PPO and the Aetna Dental DMO compare: Aetna Dental PPO Aetna Dental DMO Plan Features In . reside. Effective Date: 07-01-2022 878737 Dental Benefits Summary CENTER SCHOOL DISTRICT Active PPO Any exclusion above will not apply to the extent that coverage of the charges is required under any law that applies to the coverage. In order for a covered person to be eligible for benefits, dental services must be provided by a primary care dentist selected from the network of participating DMO dentists. 2022 Summary Plan Descriptions. When an examination and/or materials are received from a VSP participating provider, the patient will have no out-of-pocket expense other than the copayment, unless optional lenses are selected. Deductible. 75% of cost. Those for treatment by other than a dentist, except that scaling or cleaning of teeth and topical application of fluoride may be done by a licensed dental hygienist. Effective Date: 01-01-2022 Dental Benefits Summary AON ACTIVE EXCHANGE (b) a crown, bridge, or cast or processed restoration if a tooth was prepared for it before the person became a covered person; or (c) root canal therapy if the pulp chamber for it was opened before the person became a covered person. Dental Benefits Summary. Effective Date: 01-01-2022 (b) under any other plan of group benefits provided by or through your employer. j marion sims primary source. Benefit Summary. Aetna DMO: Pennsylvania Residents: Summary Plan Description; DMO Copay Schedule ; Find a DMO or PPO Dentist; Find a Vision Provider; Termination Policy; Request an ID card: — Dental — Vision; Payroll Allotment Form; Direct Debit Application Form; Authorized Representative Form . This Aetna Dental® Preferred Provider Organization (PPO) benefits summary is provided by Aetna Life Insurance Company for some of the more frequently performed dental procedures. These limits are described in the booklet/certificate. . Comprehensive Dental Insurance Plans (PPO and DHMO available) Coverage for regular exams, cleanings, x-rays, root canals, crowns, implants and braces. This applies Please note: Aetna members of any one of the Medical, Dental or Vision plans listed above, can enjoy a 10 percent discount from specific CVS oral care products. These limits are described in the booklet/certificate. The table below summarizes how each plan covers dental expenses and shows what each plan pays. Verizon Business DMO Plan 58 Dental Benefit Summary CODE PROCEDURE Office Visit Copay PATIENT PAYS CODE $10 DIAGNOSTIC No Charge D2140 No Charge . 2. 10/06/2015 www.aetna.com 1 Dental Benefits Summary THE NEW YORK AND PRESBYTERIAN HOSPITAL Effective Date: 01-01-2022 This benefits summary of the Aetna Dental DMO (Dental Maintenance Organization) provides information on benefits provided when services are rendered by a participating dentist. Under the Dental Preferred Provider Organization (PPO) plan, you In order for a covered person to be eligible for benefits, dental services must be provided by a primary care dentist selected from the network of participating DMO dentists. A Nationwide Dental PPO Plan Who may enroll in this plan: All Federal employees, annuitants, and certain TRICARE beneficiaries in the United States and overseas who are eligible to enroll in the Federal Employees Dental and Vision Insurance Program IMPORTANT • Rates: Back Cover • Changes for 2022: Page 4 • Summary of Benefits: Page 43 2022 Plan. Summary of Benefits and Coverage (SBC) Learn more about 2022 benefit options. About Your Benefits. Guide to Benefits; Summary of Benefits Coverage Aetna has one of the nation's largest dental networks, with more than 200,000 participating dental practices, making it easy to find a great dentist or specialist near you The Aetna DMO is a Dental Maintenance Organization Aetna Dental Maintenance Organization (DMO): Under this plan, monthly . Dental benefits are provided to eligible dependents up to age 26. You don't have to submit claims to your insurance company, as your primary care dentist takes care of that. Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual + Family | Plan Type: PPO Coverage Period: 12/01/2016 - 11/30/2017: OH PPO 2500 80/50 Questions: Call 1-888-802-3862 or visit us at www.HealthReformPlanSBC.com. Delta Dental of Michigan—a traditional dental coverage plan AETNA DMO AND AETNA PREMIUM DMO* Aetna DMO utilizes primary care dentists to lower the cost—it is a managed-care . photos, directions, phone numbers and more for Aetna Dental Dmo locations in Jacksonville, FL Your user name stays the same, even if you change jobs or the type of insurance Guide to Benefits; Summary of Benefits Coverage Guide to Benefits; Summary of . Plan Feature. 2022 Basic Option PPO Plan; Group# 397432 (877) 238-6200. Aetna Managed Dental Plan (DMO) In-Network only. Download PDF . This applies In order for a covered person to be eligible for benefits, dental services must be provided by a primary care dentist selected from the network of participating DMO dentists. It is not an HMO. Effective January 1, 2022 through December 31, 2022: Semi-Monthly Dental Plan Rates (Per Paycheck): Dental Plan: Aetna Dental DMO Individual: $2.76 Individual + 1: $7.08 Family: $14.21. Dental Benefits Summary: Effective Date: 01-01-2022 Plan 51 809536 D6062 $325 D6624 $295 D6063 $325 D6634 $295 D6064 $325 D6710 $325 Effective Date: 01-01-2022 (a) a non-occupational disease; or (b) a non-occupational injury. Services that Aetna defines as not necessary for the diagnosis, care or treatment of the condition involved. The DMO plan requires that you visit participating DMO providers in order to be covered. Your DMO election does not carry over from year to year In Texas by Aetna Dental Inc Your Aetna health benefits or insurance plan may pay part of the doctor's bill Box 10462 Van Nuys, CA 91410 https://www https://www. 0. The Aetna Dental DMO is . %$ +roglqjv ,qf '02 'hqwdo %hqhilwv 6xppdu\ (iihfwlyh 'dwh 3odq ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' %$ +roglqjv ,qf '02 'hqwdo %hqhilwv 6xppdu\ (iihfwlyh 'dwh 3odq ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' 16. Aetna Dental PPO SPD. Aetna DMO: New Jersey Residents: DMO Dental - New Jersey Specialty Care Dental Services Booklet. Original Medicare, on the other hand, does not cover routine dental care, such as cleanings, X-rays . With the DMO, a participant does not have to meet a deductible or file any claim forms. . Effective Date: 01-01-2022 Dental Benefits Summary (i) after the end of the 12-month period starting on the date the person became a covered person; or 14. Current Premiums for Dental DMO. Dental Plan Rates 2022 Dental Plan - Partial Subsidy Contributions (for employees working between 20-29.9 hours per week) Aetna PPO Plan Aetna DMO Plan MONTHLY BIWEEKLY MONTHLY BIWEEKLY Employee only $33.76 $16.88 $20.94 $10.47 2-Person $72.00 $36.00 $43.32 $21.66 Family $121.00 $60.50 $68.42 $34.21 2022 Dental Plan - Full Subsidy Contributions Dental Benefits Summary Fulton County 842888 Effective Date: 01-01-2022 (b) as prescribed for any period of open enrollment agreed to by the employer and Aetna. 2022 Aetna Dental PPO Benefit Summary. Please check your plan booklet for details. SAMBA'S DENTAL & VISION PLAN . Effective Date: 01-01-2022 809536 (b) as prescribed for any period of open enrollment agreed to by the employer and Aetna. When emergency services are provided by a participating PDN dentist, your co-payment/coinsurance amount will be If Aetna's payment to the specialty dentist is based on a negotiated fee, then the member's copayment for the service will be based on the same negotiated fee. Dental Rates for 2022 At-A-Glance Contact List Plan Offering Comparison Aetna DMO Dental Plan Summary Aetna PPO Dental Plan Summary 2022 Annual Enrollment Correspondence . Maximum allowable for all Low Vision benefits of. How the Plan Works For more information, call 1-877-698-4754, prompt 6, press 3. DMO Member Responsibility Annual Deductible Individual None Family None Preventive Services 0% Basic Services 20% Major Services 50% Annual Benefit Maximum None Office Visit Copay $5 Orthodontic Services (Adult and Child) Not Covered Orthodontic Deductible Not Covered Orthodontic Lifetime Maximum Not Covered Partial List of Services DMO This does not apply to charges incurred: 9. D6117. In Virginia, Aetna DMO® is called Aetna DNO. The Aetna Dental PPO plan offers both in- and out-of-network coverage. 1. 0. . Save up to 35% with over 135,000 in-network dentists at more than 410,000 locations nationwide. Aetna PDN (Low Option) In-Network and Out-of-Network1. for an amalgam restoration plus the difference between the dentist's Aetna approved fees for the resin restoration and the amalgam restoration. Aetna PDN (High Option) In-Network and Out-of-Network2. DENTAL BENEFIT RIDER . Mid PPO Dental Benefits Summary Effective Date: 01-01-2022 (b) as prescribed for any period of open enrollment agreed to by the employer and Aetna. Links to ClaimConnect and its content are provided for your convenience. Dental. Learn more about Aetna CVS Health Affordable Care Act (ACA) individual health insurance plans. aetna dental ppo fee schedule 2021 pdf . Author: Lionel Lamb. This Benefit summary of the Aetna Dental Maintenance Organization (DMO®) provides information on benefits provided when services are rendered by a participating dentist. You're not required to choose a primary care . Aetna PDN (Low Option) In-Network and Out-of-Network1. 2022 Plan. . Cigna International Dental. Effective Date: 01-01-2022 800463: Dental Benefits Summary: Mattel, Inc. 7. NOTE: If there is not a network in the area where you reside, you may select a PCD in the area where you work, provided a network is available. This Aetna Dental® Preferred Provider Organization (PPO) benefits summary is provided by Aetna Life Insurance Company for some of the more frequently performed dental procedures. 2022 Plan. If you would like to sign up for the 1199SEIU Aetna (DMO) plan . in-network out-of-pocket maximum of $3,500 for an individual and $7,000 for a family, the Choice In-Network plan pays 100% of covered medical charges for the remainder of the calendar year Also, some plans cover out-of-network care only in an emergency The Aetna DMO Dental Plan offers narrow networks, deeper discounts on covered services and reduced rates for Intuit . A primary care dentist coordinates all of your care. *This is a partial list of exclusions and limitations, others may apply. Delta Dental PPO - Low. $1000.00 every two (2) years. When you combine quality coverage and insurance expertise with local walk-in care options and convenient access, the end result is a new way to experience health care. DMO® Member Responsibility Annual Deductible Individual None Family None Preventive Services 0% Basic Services 0% Major Services 40% Annual Benefit Maximum None Office Visit Copay $5 Orthodontic Services (Adult and Child) 50% Orthodontic Deductible None Orthodontic Lifetime Maximum *** Partial List of Services DMO® 2022 Aetna DMO/DNO Benefit Summary. Active PPO MAX Consult Aetna Dentals online provider search for the most current provider listings. The Plan offers a choice between two Dental Plan Options: OPTION 1: Dental Maintenance Organization (DMO®) Plan Option Simply select a Primary Care Dentist who participates in the Aetna Dental Maintenance Organization (DMO . This Aetna Dental® Preferred Provider Organization (PPO) benefits summary is provided by Aetna Life Insurance . Plan Type. DMO patients pay less in premiums and out-of-pockets expense than dental PPO patients do. 2022 . . $50 per person $150 per family. Plan Feature. The Aetna Dental PPO plan offers an in-network annual (calendar year) maximum benefit of $2,000 per person and an out-of-network annual (calendar year) benefit maximum of $1,500 per person, once the annual deductible ($50 for an individual, $150 for a family) has been satisfied. an amalgam restoration plus the difference between the dentist's Aetna approved fees for the resin restoration and the amalgam restoration. Part 1; Part 2; Part 3; . To Passive PPO receive maximum benefits, members must choose a participating . Dental . 2022 Aetna Dental PPO Benefits Summary. 2022 Summary Plan Description (SPD) for Aetna DPPO plan. Dental Benefits Summary Effective Date: 01-01-2022 Surgical removal of impacted tooth (partial bony/ full bony)* 50% Implants 50% Aetna Dental Care RewardSM Plan (a) Frequency and/or age limitations may apply to these services. In order for a covered person to be eligible for benefits, dental services must be provided by a primary care dentist selected from the network of participating DMO . The benefits and provisions of the Plan as of January 1, 2022, are described in this Summary Plan Description (SPD).
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