Your Payer Express log in may be different from your Aetna secure member site log in. Youll pay for your dental care up front when you see a dentist, and then submit your receipts to Aetna for reimbursement. 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 Dental Direct PPO Plans are Subject to the Following Rules: Replacement Rule Actual costs and savings may vary by provider, service and geographic location. You may pay more when you get care from dentists who arent in the network.**. New and revised codes are added to the CPBs as they are updated. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". 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. 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. Your dental plan may have yearly and lifetime limits on coverage. 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 . This material is for information only. your coverage will begin on January 1, 2022. CPT only Copyright 2022 American Medical Association. Links to various non-Aetna sites are provided for your convenience only. 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. Aetna Invisalign Coverage Your Aetna plan might cover your Invisalign treatment, although it depends entirely on the plan. The EOC is the legal contract between you and the Medicare plan. Members must enroll in this option when they enroll in their plan, or within 30 days of their plans start date. That are provided by a family member. 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. But your plan features and costs will vary depending on the plan you choose. Disclaimer of Warranties and Liabilities. Get coverage to any doctor (in or out-of-network) at the same member cost share. Dental benefits are already included inthe majority ofAetna MA plans. 151 Farmington Avenue, Hartford, CT 06156. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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). You are now being directed to the CVS Health site. 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). Understand the link between infections in the mouth, and their impact on other parts of the body. And withAetna MA plans, you have a variety of options to make it more affordable and easierto keep up withyourdental care. Si tu intencin no era salir del sitio web, cierra este mensaje. The availability of a particular provider cannot be guaranteed and provider network composition is subject to change. Deductible and annual maximum amounts cross-apply between in network and out of network. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. You are leaving our Aetna Medicare website and going to an Aetna Medicaid website. The Appointment of Representative form is on CMS.gov. 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. Aetna Dental PPO Plan More reasons to smile Worldwide dental coverage and plans with no deductible New Hires have 60 days to choose benefits. 2022 . Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental 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. Be sure to make copies of all of your paperwork. Aetna Dental Savings Plans are NOT dental insurance and the dental savings will vary by provider, plan and zip code. This information is neither an offer of coverage nor medical advice. These dental benefits follow the same structure as network plans and may require you to choose a dental provider within your network. Find your dentist now in Aetna's large nationwide network. Links to various non-Aetna sites are provided for your convenience only. Dental plans are all different. No fee schedules, basic unit, relative values or related listings are included in CPT. 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. You are leaving our Medicare website and going to our non-Medicare website. Aetna Dental Direct | Secure Member Portal Login Secure Member Portal * required Username * Forgot Username? 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. Do you cover adult orthodontia? The member's benefit plan determines coverage. the difference in cost between the approved less costly service and the more costly covered service. What does the Aetna Dental PPO Plan cover? Temporomandibular joint dysfunction/disorder. Remember Username Secure Login First time here? 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. Links to various non-Aetna sites are provided for your convenience only. Whats covered under Medicare Advantage dental plans. If youre submitting your form online, be sure to attach your receipt to your submission. 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. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. The Aetna Dental Direct plan covers preventative care 100% with no out of pocket cost. 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. ChooseHealthy is a federally registered trademark of ASH and used with permission herein. Applicable FARS/DFARS apply. The plan offers preventive treatment at 100% with no out of pocket cost. Aetna dental plans are not considered to be qualified health plans under the Affordable Care Act. By texting 90156, you consent to receive a one-time marketing automated text message from Aetna with a link to download the Aetna Health app. Learn more about our network and DMR plans Search other providers Need a provider directory? Do you want to continue? Treating providers are solely responsible for dental advice and treatment of members. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. 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. 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. A primary care dentist (PCD) helps guide your care with this DMO* plan. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Aetna handles premium payments through Payer Express, a trusted payment service. Cigna DPPO networks offer convenient access to quality dentists all across the country and savings on covered dental services. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Applicable FARS/DFARS apply. 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. 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. Claims must be submitted within 365 days of the date you received the service. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 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. Were bringing you to our trusted partner to help process your payments. 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. 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). Covered family members can choose their own PCDs. Teeth whitening and facings on molar crowns and pontics will always be considered cosmetic. Since there is no paperwork or reimbursement, you must pay for the service at the time its provided. 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 No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Visit a dentist in the Aetna Dental PPO* network. Enrollment in this voluntary dental plan is open to all registered students and their eligible dependents. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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. These typically include some level of dental coverage, including twice-yearly oral health exams, teeth. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. That would not be made if you did not have coverage. Routine dental care can help you have stronger teeth, healthier gums and a brighter smile.
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