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. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Do you cover Invisalign braces? You have the freedom to care for your smile your way with this PPO plan. Each main plan type has more than one subtype. What does the Aetna Dental PPO Plan cover? If you do not intend to leave our site, close this message. ChooseHealthy is a federally registered trademark of ASH and used with permission herein. Once youre a member, you have two ways to engage with your plan online. Learn more about our network and DMR plans Search other providers Need a provider directory? Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. The three carriers providing service to the District's employees are CompBenefits/Humana (Basic and Enhanced PPO/Indemnity and DHMO Managed Care), Aetna (Basic and Enhanced PPO/Indemnity), and Aetna (Basic and Enhanced DHMO Managed Care). This material is for information only. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Choose from leading manufacturers and get free follow-up service for one year. All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. are covered at 100% on most plans. This information is neither an offer of coverage nor medical advice. However, if you do this, you wont benefit from negotiated rates. Teeth whitening and facings on molar crowns and pontics will always be considered cosmetic. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. This means you pay nothing out of pocket if you stay in network. Please log in to your secure account to get what you need. AetnaDentalOffers.com is brought to you by DentalPlans.com. 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). Click the Register button to get started. 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. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-877-698-4825, is the Discount Medical Plan Organization. Others have four tiers, three tiers or two tiers. That are not medically necessary. The member's benefit plan determines coverage. 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. 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) Aetna Direct Core PPO comes with lower premiums, and Direct Preferred PPO provides more favorable splits in payment for basic procedures like fillings and extractions. 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. Participating dentists have agreed to provide services at a negotiated rate for covered services. Cancelled or missed appointment charges or charges to complete claim forms. Unlisted, unspecified and nonspecific codes should be avoided. For someAetna MA plansthatdontincludedental coverage, you mayhave the choiceof payingextra each month for dental benefits. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Aetna Dental Direct | Secure Member Portal Login Secure Member Portal * required Username * Forgot Username? 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. It is only a partial, general description of plan or program benefits and does not constitute a contract. The maximum deductible for 2022 is $480, but this plan (Aetna Medicare Choice Plan (PPO)) has a $200. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. When billing, you must use the most appropriate code as of the effective date of the submission. Language services can be provided by calling the number on your member ID card. 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 you'll save more if you stay in network Annual Deductible $50 Per Person $150 Per Family, per calendar year Network dentists offer special rates for covered services. By submitting your information you are agreeing to receive communications from Aetna Dental Offers. Applicable FARS/DFARS apply. Accessibility Services:If you are a person with a disability who needs assistance using our websites, our Customer Service Representatives can assist you. You are now being directed to the CVS Health site. 5 Visit AetnaMedicare.com to learn more about the 2022 Aetna Medicare plans. 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). 5. 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. 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 For additional language assistance: Espaol | | Ting Vit | | Tagalog | P | | Kreyl | Franais | Polski | Portugus | Italiano | Deutsch | | | Other Languages. 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. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Persons with a hearing or speech disability can use 711 for Telecommunications Relay Service (TRS). This is the total amount per person your plan will pay toward the in-network cost of dental care each year. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Temporomandibular joint dysfunction/disorder. Is there a maximum dental benefit? Enrollment in our plans depends on contract renewal. With Aetna Vital Savings, you can choose from more than 250,0001 available dental practices across the country. your coverage will begin on January 1, 2022. Visit any licensed dentist outside the network. Selection of a program provider is also the responsibility of the participant and is not based on any representations by Aetna. See the insurance policy for details. With Aetna MA plans that include a direct member reimbursement (DMR) allowance, members are given a set amount of money to spend each year on dental care. This search will use the five-tier subtype. PGCPS pays 75% of monthly premium for dental, the PGCPS share increases to 80% after 8 years of service. Once youre a member, heres how you can connect: 1. Cigna DPPO plan features 1. The EOC is the legal contract between you and the Medicare plan. The information you will be accessing is provided by another organization or vendor. In case of a conflict between your plan documents and this information, the plan documents will govern. Network dentists offer special rates for covered services. 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. It is not available in Montana, Vermont or Tennessee. The availability of a particular provider cannot be guaranteed and provider network composition is subject to change. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. These typically include some level of dental coverage, including twice-yearly oral health exams, teeth. 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. 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. Get coverage to any doctor (in or out-of-network) at the same member cost share. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Dental information programs provide general dental information and are not a substitute for diagnosis or treatment by a dentist or other health care professional. 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.
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