Aetna will continue to offer most Medicare Advantage members access to routine vision, dental and hearing coverage. Dental benefits are already included inthe majority ofAetna MA plans. You also have the flexibility to visit a licensed dentist who does not participate in our network. ***Certain brands impose a no-discount policy. Aetna offers two Dental PPO insurance plans to individuals and families, the Aetna Dental Direct Preferred and the Aetna Dental Direct Core. **Through the ChooseHealthy program, which is provided by ChooseHealthy, Inc., a subsidiary of American Specialty Health Incorporated (ASH). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. The Aetna Dental Direct plan covers preventative care 100% with no out of pocket cost. All Rights Reserved. That are provided by a family member. All Rights Reserved. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Get discounts on oral health care products like Z Sonic toothbrushes, replacement brush heads and various oral health care kits. No fee schedules, basic unit, relative values or related listings are included in CPT. Print and fill out the reimbursement form. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 1According to the Aetna Enterprise Provider Database as of May 1, 2018. When you have an Aetna Dental plan, you know youre taking the right steps toward being healthy. Learn more about our network and DMR plans Search other providers Need a provider directory? ZIP CODE View 2023 plans Learn about these benefits Dental, eyewear and hearing coverage is available. You are leaving our Medicare website and going to our non-Medicare website. In excess of the benefit, dollar, day, visit, or supply limits stated in your schedule of benefits. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. Allow approximately 4-6 weeks for reimbursement. Pay less for acupuncture,* chiropractic visits, therapeutic massage and nutrition services** and for products like wearable fitness devices and fitness kits. Aetna Vital Savings provides participants with access to a network of independent practicing providers. 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). For language services, please call the number on your member ID card and request an operator. PLAN EXCLUSIONS AND LIMITATIONS* We encourage you to check with your participating provider prior to beginning treatment. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Claim FAQ. 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. *** Terms and conditions: Bit.ly/2nlJFYG. Includes PPO, HMO, HMO-POS medical plans with or without drugs. Your dental plan pays the rest. 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. 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. You get access to discounts off the regular charge on products and services offered by third-party vendors and providers. your primary care dentist will refer you to one in our network. You can also submit paper claims. Links to various non-Aetna sites are provided for your convenience only. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Everyone can get their own in-network primary care dentist. When you see a dental care provider for services, you pay up front and get a receipt that includes a description of the services provided. Altius Health Plans: HMO (PDF) - UT, ID (Southwest & Eastern), WY (Uinta County) HDHP (PDF) - UT, ID (Southwest & Eastern), WY (Uinta County) For information about our plans available through the Federal Employees Dental and Vision Insurance Program (FEDVIP), please visit our Dental PPO Plan site or our Aetna Vision Preferred plan site. Members must enroll in this option when they enroll in their plan, or within 30 days of their plans start date. Treating providers are solely responsible for medical advice and treatment of members. Find your dentist now in Aetna's large nationwide network. . 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. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. 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. Orthodontic treatment except as covered in the Eligible Dental Services section of your insurance policy Information is believed to be accurate as of the production date; however, it is subject to change. 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. Treating providers are solely responsible for dental advice and treatment of members. 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. Aetna may receive a percentage of the fee you pay to the discount vendor. Please log in to your secure account to get what you need. Certain preventive care services are covered at little-to-no-extra cost 2 when . Register Just check with your employer to see which plans are available to you. Surgical removal of impacted wisdom teeth when only for orthodontic reasons Do you want to continue? Aetna handles premium payments through InstaMed, a trusted payment service. Dental PPO insurance plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). Alternate Treatment Rule Please consult with the respective plan detail page for additional plan terms. Select a state below to update coverage details. Are there any waiting periods? Aetna Invisalign Coverage Your Aetna plan might cover your Invisalign treatment, although it depends entirely on the plan. Treating providers are solely responsible for medical advice and treatment of members. You are now being directed to CVS Caremark site. You may be balance billed by out-of-network dentists up to the dentists standard fee. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. If you do not intend to leave Aetna Medicare, close this message. CPT is a registered trademark of the American Medical Association. 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). Accessibility Services:If you are a person with a disability who needs assistance using our websites, our Customer Service Representatives can assist you. In case of a conflict between your plan documents and this information, the plan documents will govern. All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. See dentists both in and out of our network. Links to various non-Aetna sites are provided for your convenience only. Do you cover Invisalign braces? This search will use the five-tier subtype. It may be different from your Aetna secure member site log in. 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. Links to various non-Aetna sites are provided for your convenience only. Provided by an out-of-network provider in excess of the recognized charge. Each main plan type has more than one subtype. That are not medically necessary. 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. The Appointment of Representative form is on CMS.gov. Not available in many states. 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. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Cigna DPPO networks offer convenient access to quality dentists all across the country and savings on covered dental services. Whether youre at your desk or on the go, our easy-to-use digital tools help you manage your dental plan, save money and make smart decisions about your care. SBBC now offers the option of four dental plans available from three dental carriers. the difference in cost between the approved less costly service and the more costly covered service. Aetna Medicare is a HMO, PPO plan with a Medicare contract. 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. There also may be age and frequency limits on some services. 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. But do you know that your oral health is linked to many medical conditions? 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. Aetna Dental has over 50 years of experience offering dental benefits. 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. To learn more about using your Aetna MA dental benefits, read our guide below. The information you will be accessing is provided by another organization or vendor. If you have more questions, just call us at 1-866-241-0356 (TTY: 711), Monday through Friday, 8 AM to 9 PM ET. 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 member's benefit plan determines coverage. Youll need to select a primary care dentist in the DMO network. In MD and NJ, student medical insurance is underwritten by Aetna Health and Life Insurance Company (AHLIC).Self-insured plans are funded by the applicable school, with claims administration services provided by Aetna Life Insurance Company. With our HMO-POS plans, you can enjoy all the benefits of receiving medical care through a network provider. What does the Aetna Dental PPO Plan cover? Direct member reimbursement allowance: How to get reimbursed for dental care. All Rights Reserved. For more information, please call HSA Consulting Customer Service at (888) 978-8355. Taking care of your teeth is as an important part of taking care of your health. While we encourage you to submit all claims electronically, if you need to submit a paper claim, Review our paper claim Tips. Members should discuss any matters related to their coverage or condition with their treating provider. By submitting your information you are agreeing to receive communications from Aetna Dental Offers. 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. So, you wont see cost information here. AetnaDentalOffers.com is brought to you by DentalPlans.com. Understand the link between infections in the mouth, and their impact on other parts of the body. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Some plans exclude coverage for services or supplies that Aetna considers medically necessary. First time users can also sign up and register for an account. ${tty} to chat about any Medicare questions you have. That would not be made if you did not have coverage. 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. All services deemed "never effective" are excluded from coverage. You should: Review the Electronic Claim Vendor List Electronic Claim Vendor List. Use order code 123AET200. Dual Enrollment If you sign up for a dental and/or vision plan during the 2022 Open Season, your coverage will begin on January 1, 2023. Persons with a hearing or speech disability can use 711 for Telecommunications Relay Service (TRS). Language services can be provided by calling the number on your member ID card. You will receive the discount off the providers usual and customary fees when you pay. Note not all plans and offers available in all markets. Treating providers are solely responsible for medical advice and treatment of members. Click here to review plans with a $0 deductible. Visit any licensed dentist outside the network. * In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). The SBC shows you how you and the plan would share the cost for covered health care services. 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. Aetna dental insurance for seniors offers three different plans to choose from. 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. Links to various non-Aetna sites are provided for your convenience only. Disclaimer of Warranties and Liabilities. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Links to various non-Aetna sites are provided for your convenience only. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Links to various non-Aetna sites are provided for your convenience only. Sign up at BeneFeds.com or call 1-877-888-3337. Learn about Medicare Advantage The replacement of; addition to; or modification of: existing dentures; crowns; casts or processed restorations; removable denture; fixed bridgework; or other prosthetic services is covered only if specific criteria are met. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 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. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. 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. This material is for information only. Dental care, eyewear and hearing aids Many of our Medicare Advantage plans include dental, eyewear and hearing benefits. Find the right plans and programs for you. Want to see options for a different location? Deductible applies to basic and major services only. 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. It's generally known as the Evidence of Coverage (EOC). Student health insurance plans are underwritten by Aetna Life Insurance Company (Aetna). For more info about your no-cost OneTouch BGM for Aetna Medicare plan members, you can visit us online or call 1-877-764-5390 ${tty} without a prescription. 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. 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. 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. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. With Aetna Dental Direct, youll get the coverage you need to keep your teeth healthy. 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. The ABA Medical Necessity Guidedoes not constitute medical advice. Top 3 reasons to choose Aetna Dental These dental benefits follow the same structure as network plans and may require you to choose a dental provider within your network. Original Medicare, on the other hand, does not coverroutinedental care, such as cleanings, X-rays,andfillings. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. For more details see our Privacy Policy. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Copyright 2015 by the American Society of Addiction Medicine. 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. Choose a PCD from our network**: Use ourprovider search toolto find one. Provider Directory Last Updated: April 22, 2023 Page Last Updated: January 27, 2023 Digital tools to easily manage your care and access your ID card whenever needed. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. 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. So your share of the cost is usually lower. 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. CPT only Copyright 2022 American Medical Association. No fee schedules, basic unit, relative values or related listings are included in CPT. Aetna Student Health is offering a Dental Preferred Provider Organization (PPO) planto Columbia University students and their eligible dependents. Dental care is a vital part of maintaining yourhealth and well-being, especially as you age. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Aetna MAplans offer three types of dental benefits:network,direct memberreimbursementallowanceand optional supplemental benefits. For work that began before you were covered under the plan, The following dental services and supplies. You are now being directed to the CVS Health site. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. And one of the main perks of joiningaMedicare Advantage (MA)planis that many plans offer dental coverage to helpyoukeep upwithyour oral health. Very low rates. Learn more and see if your dentist is in the network with these plans on aetna.com. Studies show that a healthy mouth helps you avoid health problems in the body, too. New and revised codes are added to the CPBs as they are updated. Provided for your personal comfort or convenience, or the convenience of any other person, including a dental provider. Links to various non-Aetna sites are provided for your convenience only. 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. Reprinted with permission. 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. Dual Eligible Special Needs Plans (D-SNP). 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. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). your coverage will begin on January 1, 2022. 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 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. 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 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. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The AMA is a third party beneficiary to this Agreement. To view the form just select Continue. 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. But your plan features and costs will vary depending on the plan you choose. Temporomandibular joint dysfunction/disorder. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Network dentists offer special rates for covered services. offering the same type of coverage; i.e., you (or covered family members) cannot be covered by two FEDVIP dental plans or two FEDVIP vision plans. You have the freedom to care for your smile your way with this PPO plan. Choose from leading manufacturers and get free follow-up service for one year. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. CPT is a registered trademark of the American Medical Association. 2022 Aetna Dental 2 Enroll at www.BENEFEDS.com . Please be sure to add a 1 before your mobile number, ex: 19876543210. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Aetna does not provide dental, medical, vision or other health care/treatment. 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. 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. Texas Members: In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). Aetna Dental plans come with special perks and discounts, including exclusive offers from CVS Health. You can change your PCD once a month on your member website. The availability of a particular provider cannot be guaranteed and provider network composition is subject to change. 151 Farmington Avenue, Hartford, CT 06156. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Please be sure to add a 1 before your mobile number, ex: 19876543210, Use our provider search tool to search, in the network, by name, specialty or procedure, See your benefits summary and get information about what's covered, Pull up your ID card whenever you need it. Brushing, flossing and getting regular dental checkups help to keep your mouth healthy. 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 The school has chosen a plan that makes it easy to keep your smile. 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. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. You are now being directed to the CVS Health site. 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. Or it may be coinsurance, which is a percentage of the dentists charge. You may pay more when you get care from dentists who arent in the network.**. See your Evidence of Coverage for details. 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. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Caring for your teeth should never feel out of reach with Aetna Dental Direct. 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.
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