Print and fill out the reimbursement form. 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. Visit any licensed dentist outside the network. 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. 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. CPT is a registered trademark of the American Medical Association. We make dental care convenient. Check with your plan for more details. *Based on January 2023 Aetna provider data If you have questions about your Medicare plan, start here. Aetna Invisalign Coverage Your Aetna plan might cover your Invisalign treatment, although it depends entirely on the plan. Use order code 123AET200. 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. Treating providers are solely responsible for dental advice and treatment of members. 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. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan 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. Sign up at BeneFeds.com or call 1-877-888-3337. Most of our HMO-POS plans require you to use a network provider for medical care but provide you with flexibility to go to licensed dentists in or out of network for routine dental care. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. You pay up front for dental care and submit receipts for reimbursement. Your dental plan pays the rest. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Get discounts on oral health care products like Z Sonic toothbrushes, replacement brush heads and various oral health care kits. Understand the link between infections in the mouth, and their impact on other parts of the body. 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. Give your member information at your visit. 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. We're here 8 a.m. - 8 p.m., Monday through Friday. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The plan offers preventive treatment at 100% with no out of pocket cost. With Aetna Dental Direct, you'll get the coverage you need to keep your teeth healthy. Aetna dental insurance comes with stand-alone dental coverage or dental, vision, and hearing coverage. The plan offers preventive treatment at 100% with no out of pocket cost. 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 That are experimental or investigational. 151 Farmington Avenue, Hartford, CT 06156. Links to various non-Aetna sites are provided for your convenience only. And you don't have to have Aetna medical or other coverage with us to purchase. 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). When billing, you must use the most appropriate code as of the effective date of the submission. Information is believed to be accurate as of the production date; however, it is subject to change. All care is the responsibility of the treating provider, in consultation with the participant. Enjoy discounts on hearing aids, exams and hearing aid batteries mailed to your home. These dental benefits follow the same structure as network plans and may require you to choose a dental provider within your network. Preventive services Waiting period*: None, Basic services are covered at 80% with in-network providers (after deductible), 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 youll save more if you stay in network, 100% coverage for preventive services when you see an in-network dentist, Basic services covered at 80% with in-network providers (after deductible), Major services covered at 50% with in-network providers (after deductible), Waiting periods* for Basic and Major services waived with prior dental insurance, $50 individual / $150 family per calendar year, Waiting period is waived if all family members enrolling had dental coverage within the past 90 days. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). How is coverage handled overseas? You get access to discounts off the regular charge on products and services offered by third-party vendors and providers. Some subtypes have five tiers of coverage. 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. And one of the main perks of joiningaMedicare Advantage (MA)planis that many plans offer dental coverage to helpyoukeep upwithyour oral health. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. You can choose from one of the more than 420,000* dental providers nationwide. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Not available in many states. 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. Top 3 reasons to choose Aetna Dental Click here to review plans with a $0 deductible. As you age, maintaining your oral health is an important part of your whole-body wellness. Use order code 123AET200. Aetna may receive a percentage of the fee you pay to the discount vendor. Aetna Medicare SM Plan (PPO) Learn more about Aetna Feeling Good: Your Verizon Aetna magazine Check out Feeling good , the magazine created specifically for Verizon Aetna members. Annual Deductible $50 Per Person $150 Per Family, per calendar year, Annual Maximum Benefit $1,250 per covered person. See the insurance policy for details. 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. Persons with a hearing or speech disability can use 711 for Telecommunications Relay Service (TRS). Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". So your share of the cost is usually lower. Surgical removal of impacted wisdom teeth when only for orthodontic reasons With adirect member reimbursementallowance, youre givena set amount of money to spend each year on dental care.. All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. Disclaimer of Warranties and Liabilities. But your plan features and costs will vary depending on the plan you choose. Aetna Dental has over 50 years of experience offering dental benefits. What does the Aetna Dental PPO Plan cover? Important Disclaimers for Medicare Members For questions on your dental benefits, call us 1-866-409-0937 (TTY: 711). Your Payer Express log in may be different from your Aetna secure member site log in. Direct member reimbursement allowance: How to get reimbursed for dental care. Everyone can get their own in-network primary care dentist. Visit a dentist in the Aetna Dental PPO* network. 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. 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. The EOC is the legal contract between you and the Medicare plan. 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. Texas Members: In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). You are leaving our Medicare website and going to our non-Medicare website. There are no claims or referrals to worry about, and no limits on how much you can save. By submitting your information you are agreeing to receive communications from Aetna Dental Offers. 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. Premium deductions will start with the first full pay period Provided by an out-of-network provider in excess of the recognized charge. 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 Network dentists also file claims for you. How we make it simple for you About Medicare Advantage We're here to help you learn more about what you can get out of Medicare Advantage. Cons. With Aetna Vital Savings, you can choose from more than 250,0001 available dental practices across the country. Aetna Dental Savings Plans are NOT dental insurance and the dental savings will vary by provider, plan and zip code. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. It is only a partial, general description of plan or program benefits and does not constitute a contract. Premium deductions will start with the first full pay period No fee schedules, basic unit, relative values or related listings are included in CPT. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. . You are now being directed to CVS Caremark site. Or log in to your member account to submit the form online. With our HMO-POS plans, you can enjoy all the benefits of receiving medical care through a network provider. The Appointment of Representative form is on CMS.gov. Visit a dentist in the Aetna Dental PPO* network. 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 Very low rates. 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 * In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). Si tu intencin no era salir del sitio web, cierra este mensaje. PGCPS pays 75% of monthly premium for dental, the PGCPS share increases to 80% after 8 years of service. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Find your dentist now in Aetna's large nationwide network. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna's 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). You can also download it from the App Store or the Google PlayTM store. AetnaDentalOffers.com is brought to you by DentalPlans.com. You should: Review the Electronic Claim Vendor List Electronic Claim Vendor List. There also may be age and frequency limits on some services. Each main plan type has more than one subtype. Pay your share of the cost. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Go to the American Medical Association Web site. Links to various non-Aetna sites are provided for your convenience only. ZIP CODE View 2023 plans Learn about these benefits Dental, eyewear and hearing coverage is available. You are now being directed to the CVS Health site. You are now being directed to CVS Caremark site. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. your primary care dentist will refer you to one in our network. When you have an Aetna Dental plan, you know youre taking the right steps toward being healthy. 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. For additional language assistance: Espaol | | Ting Vit | | Tagalog | P | | Kreyl | Franais | Polski | Portugus | Italiano | Deutsch | | | Other Languages. Aetna will continue to offer most Medicare Advantage members access to routine vision, dental and hearing coverage. Choose a PCD from our network**: Use ourprovider search toolto find one. A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl. 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. Copyright 2015 by the American Society of Addiction Medicine. Deductible applies to basic and major services only. Instruction for diet, plaque control and oral hygiene 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. The member's benefit plan determines coverage. This material is for information only. Aetna Student Health Agency Inc. is a duly licensed broker for student accident and health insurance in the Commonwealth of Massachusetts. For additional language assistance: Choose from more than 120,000 dental providers nationwide, including providers who offer virtual visits through tele-dentistry. Information is believed to be accurate as of the production date; however, it is subject to change. If you do not intend to leave Aetna Medicare, close this message. 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. A primary care dentist (PCD) helps guide your care with this DMO* plan. Links to various non-Aetna sites are provided for your convenience only. 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. With Medicare Advantage plans that include a network dental benefit, youre covered up front for specified dental services but may be required to see a dentist within your network of providers. Visit any licensed dentist outside the network. In Pennsylvania, the waiting period is called an elimination period and most Basic services have one month waiting period. This information is neither an offer of coverage nor medical advice. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Aetna Dental PPO Plan More reasons to smile Worldwide dental coverage and plans with no deductible New Hires have 60 days to choose benefits. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Applicable FARS/DFARS apply. 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. So, you wont see cost information here. CPT is a registered trademark of the American Medical Association. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. You can choose from thousands of dental providers nationwide, including those who offer virtual dental visits. 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. If your plan doesnt include dental coverage, or you want to increase your coverage, you may have the option to purchase dental benefits with an additional monthly premium (coverage varies by plan). 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. Your benefits plan determines coverage. Links to various non-Aetna sites are provided for your convenience only. 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). It is not available in Montana, Vermont or Tennessee. 2022 - 2023 Aetna PPO Dental Plan Design and Benefits Summary. CPT only Copyright 2022 American Medical Association. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. To view the form just select Continue. If you have more questions, just call us at 1-866-241-0356 (TTY: 711), Monday through Friday, 8 AM to 9 PM ET. 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. Dental network Direct Member Reimbursement (DMR) Not sure If you're covered through a former employer, union, trust or other retirement system, then you have a dental network plan and are covered by the Aetna Dental PPO network. Selection of a program provider is also the responsibility of the participant and is not based on any representations by Aetna. Purchasing the Aetna dental discount cards is easy - online, by mail or by phone. This Agreement will terminate upon notice if you violate its terms. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 2022 Aetna Dental 2 Enroll at www.BENEFEDS.com . 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. Temporomandibular joint dysfunction/disorder. 2023 DentalPlans.com, Inc. All Rights Reserved. Get coverage to any doctor (in or out-of-network) at the same member cost share. So, your share of the cost is usually lower. Visit the secure website, available through www.aetna.com, for more information.