FEDVIP Program Highlights A Choice of Plans and . 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. 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. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. 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. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 5 Visit AetnaMedicare.com to learn more about the 2022 Aetna Medicare plans. Services and supplies provided where there is no evidence of pathology, dysfunction or disease, other than covered preventive services Treating providers are solely responsible for dental advice and treatment of members. Pay less for acupuncture,* chiropractic visits, therapeutic massage and nutrition services** and for products like wearable fitness devices and fitness kits. This is donethrough an optional supplemental benefit. Enrollment in our plans depends on contract renewal. Visit your PCD: If you see someone other than your selected PCD, you could end up paying more. This is only a summary of the plan's exclusions and limitations. 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. Password * Forgot Password? The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Understand the link between infections in the mouth, and their impact on other parts of the body. Studies show that a healthy mouth helps you avoid health problems in the body, too. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. This benefit maximum can range from about $150 to $6,000. 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 dental discounts are available through participating healthcare providers only. Rendered before the effective date or after the termination of coverage, unless coverage is continued under the Special coverage options after your plan coverage ends section of your policy. Important Disclaimers for Medicare Members For questions on your dental benefits, call us 1-866-409-0937 (TTY: 711). your coverage will begin on January 1, 2022. Very low rates. Aetna Dental provides national network coverage for Prince George's County Government through two networks: You receive greater benefit coverage when you use a provider who participates in the Aetna Dental participating network. With Aetna Dental Direct, you'll get the coverage you need to keep your teeth healthy. The ABA Medical Necessity Guidedoes not constitute medical advice. See your Evidence of Coverage for details. All Rights Reserved. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 5. Persons with a hearing or speech disability can use 711 for Telecommunications Relay Service (TRS). No claims or paperwork for in-network care. A Nationwide Dental PPO Plan Who may enroll in this plan: All Federal employees, annuitants, and . Be sure to make copies of all of your paperwork. You may pay more when you get care from dentists who arent in the network.**. Preventive services such as cleanings, oral exams and X-rays are covered at 100 percent on most plans. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. All Rights Reserved. This information is neither an offer of coverage nor medical advice. Since there is no paperwork or reimbursement, you must pay for the service at the time its provided. Information is believed to be accurate as of the production date; however, it is subject to change. To view the form just select Continue. They also have Direct Preventive, which only covers the costs of preventive dental care. 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) The availability of a particular provider cannot be guaranteed and provider network composition is subject to change. 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. Out of network: Check with your plan for more details. Use order code 123AET200. The ABA Medical Necessity Guidedoes not constitute medical advice. Consent is not required to download the app. Your dental plan may have yearly and lifetime limits on coverage. 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). 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. There are no claims or referrals to worry about, and no limits on how much you can save. Links to various non-Aetna sites are provided for your convenience only. If you do not intend to leave Aetna Medicare, close this message. Tooth Missing But Not Replaced Rule Dental care, eyewear and hearing aids Many of our Medicare Advantage plans include dental, eyewear and hearing benefits. 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. You may be balance billed by out-of-network dentists up to the dentists standard fee. You have the freedom to care for your smile your way with this PPO plan. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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). CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts. Replacement of a device or appliance that is lost, missing or stolen, and for the replacement of appliances that have been damaged due to abuse, misuse or neglect and for an extra set of dentures A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl. Unlisted, unspecified and nonspecific codes should be avoided. Acupuncture, acupressure and acupuncture therapy Replacement of teeth beyond the normal complement of 32 ***Certain brands impose a no-discount policy. California license number: OB84599. 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. 2022 Aetna Dental 2 Enroll at www.BENEFEDS.com . This information is neither an offer of coverage nor medical advice. So your share of the cost is usually lower. 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. 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. Links to various non-Aetna sites are provided for your convenience only. Note not all Aetna dental plans and offers available in all markets. your primary care dentist will refer you to one in our network. While we encourage you to submit all claims electronically, if you need to submit a paper claim, Review our paper claim Tips. Instruction for diet, plaque control and oral hygiene In case of a conflict between your plan documents and this information, the plan documents will govern. CPT is a registered trademark of the American Medical Association. Digital tools to easily manage your care and access your ID card whenever needed. Applicable FARS/DFARS apply. Choose from leading manufacturers and get free follow-up service for one year. Dental PPO insurance plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). Provider Directory Last Updated: April 22, 2023 Page Last Updated: January 27, 2023 CPT is a registered trademark of the American Medical Association. Members must enroll in this option when they enroll in their plan, or within 30 days of their plans start date. 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. 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. Aetna Dental Direct | Secure Member Portal Login Secure Member Portal * required Username * Forgot Username? While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. 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. Participating dentists have agreed to provide services at a negotiated rate for covered services. Visit any licensed dentist outside the network. Vision and hearing at no additional cost. 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. Plan 41 Effective Date: 01-01-2022 Hampshire, Middlesex, Norfolk, Plymouth, Suffolk and Worcester. CPT only copyright 2015 American Medical Association. Do you cover implants? Dental insurance plans contain exclusions and limitations. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. You can change your PCD once a month on your member website. Were bringing you to our trusted partner to help process your payments. Some subtypes have five tiers of coverage. This Agreement will terminate upon notice if you violate its terms. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Links to various non-Aetna sites are provided for your convenience only. 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. Privacy policy: Aetna.com/legal-notices/privacy.html. The information you will be accessing is provided by another organization or vendor. Get the coverage you need to keep your mouth, teeth and gums healthy. No fee schedules, basic unit, relative values or related listings are included in CPT. 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. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Or it may be coinsurance, which is a percentage of the dentists charge. Aetna Dental has over 50 years of experience offering dental benefits. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. For example, you pay 20%, and your plan pays 80%. Links to various non-Aetna sites are provided for your convenience only. Links to various non-Aetna sites are provided for your convenience only. Aetna will expand the Total Choice dental benefit introduced in 2022 to additional Individual MA HMO-POS and PPO plans. Do you want to continue? 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. Why choose ${company} Medicare Solutions? It's generally available starting in September and describes costs and benefits of your plan that will take effect on January 1 of the following year. 4. . Applicable FARS/DFARS apply. 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. 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. AetnaDentalOffers.com is brought to you by DentalPlans.com. It may be different from your Aetna secure member site log in. Thats it. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Disclaimers. With a PPO plan, you can visit any dentist you want (whether they are in or out of the network) and usually receive some coverage level. Surgical removal of impacted wisdom teeth when only for orthodontic reasons All services deemed "never effective" are excluded from coverage. 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. 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 Print dental claim form (English) This search will use the five-tier subtype. 2022 - 2023 Aetna PPO Dental Plan Design and Benefits Summary Visit any licensed dentist - in or out of network In network: Visit a dentist in the Aetna Dental PPO* network. You pay up front for dental care and submit receipts for reimbursement. Disclaimer of Warranties and Liabilities. You can start using your plan right away! Overall, it is very affordable compared to competitors and comes with many different amounts of coverage. All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. Select a state below to update coverage details. Top 3 reasons to choose Aetna Dental All Rights Reserved. Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. Youll need to select a primary care dentist in the DMO network. - It is treatment for decay or traumatic injury and teeth cannot be restored with a filling material The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. That are not medically necessary. In Pennsylvania, the waiting period is called an elimination period and most Basic services have one month waiting period. Instead, check your benefits summary to find your share of the costs. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Find your dentist now in Aetna's large nationwide network. To check that your provider participates, visit our website or call us. Check your plan's Evidence of Coverage. No fee schedules, basic unit, relative values or related listings are included in CPT. - The tooth is an abutment to a covered partial denture or fixed bridge. Once youre a member, you have two ways to engage with your plan online. It is only a partial, general description of plan or program benefits and does not constitute a contract. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Some preferred provider organization (PPO) and health maintenance organization point-of-service (HMO-POS) plans, however, do allow you to see any licensed dental provider, but you may save money by seeing a provider in our network. 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. Whats covered under Medicare Advantage dental plans. 2023 DentalPlans.com, Inc. All Rights Reserved. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Network dentists also file claims for you. 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. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. ZIP CODE View 2023 plans Learn about these benefits Dental, eyewear and hearing coverage is available. 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. For more information, please call HSA Consulting Customer Service at (888) 978-8355. You may pay more when you get care from dentists who arent in the network.**. If you have more questions, just call us at 1-866-241-0356 (TTY: 711), Monday through Friday, 8 AM to 9 PM ET. *Acupuncture is an essential health benefit, and the discount for this service may duplicate benefits if you are enrolled in a full-service plan. 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). Message and data rates may apply.***. Please be sure to add a 1 before your mobile number, ex: 19876543210. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Learn more and see if your dentist is in the network with these plans on aetna.com. We've broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. 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. This may be a copay, which is a set dollar amount. 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. They are not benefits under your insurance plan. 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. 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). ** Out-of-network benefits are paid based on recognized charge levels, as determined by Aetna and specified in your plan documents. All Rights Reserved. With Aetna Vital Savings, you can choose from more than 250,0001 available dental practices across the country. 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). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. There is one exception, however:If you needmedicaldental procedures whileyourein the hospital, Medicare may pay for those services as part of Medicare Part A (hospital insurance). Cigna DPPO plan features 1. For prescribed drugs, pre-treatments or analgesia. 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. As of April 4, 2022, Medicare covers up to eight over-the-counter COVID-19 tests each month, at no extra cost to you if you have . Want to see options for a different location? 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. Links to various non-Aetna sites are provided for your convenience only. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Register to watch this video opens in a new tab to get answers to frequently asked questions about the Verizon Advantage plan. Claims must be submitted within 365 days of the date you received the service. Each main plan type has more than one subtype. Aetna handles premium payments throughInstaMed, a trusted payment service. The material is for information only. If youre submitting your form online, be sure to attach your receipt to your submission. Shop around different dental care providers in your area to compare costs and make the best use of your annual allowance. 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. The member's benefit plan determines coverage. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Aetna Dental has over 60 years of experience offering dental benefits. Use order code 123AET200. 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. Aetna will continue to offer most Medicare Advantage members access to routine vision, dental and hearing coverage. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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 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. Cigna DPPO networks offer convenient access to quality dentists all across the country and savings on covered dental services. 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. Aetna Student Health is offering a Dental Preferred Provider Organization (PPO) planto Columbia University students and their eligible dependents. Want to learn more about your dental coverage? Student health insurance plans are underwritten by Aetna Life Insurance Company (Aetna). In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. The program does not make any payments to providers. Crown, inlays and onlays, and veneers unless for one of the following: Knowing more about your plan can help you get the most from your benefits and covered services. Enrollment in this voluntary dental plan is open to all registered students and their eligible dependents. See dentists both in and out of our network. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Links to various non-Aetna sites are provided for your convenience only.
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