Dental

Dental coverage, offered through Aetna, is designed to promote good dental health for you and your eligible dependents. You automatically receive dental coverage if you are enrolled in medical coverage.

Eligibility

As a represented employee, you are eligible for coverage on your date of hire. Review the Dental Expense Plan Summary Plan Description (SPD) for details.

If You Are Eligible for Coverage Under Another Dental Plan

If you are eligible for coverage under more than one dental plan — for example, if your spouse can cover you under his or her employer’s plan — it may not mean that you will receive more benefits. Most plans coordinate benefits, meaning your total benefit is limited to what you would receive under the plan with the highest coverage level. For more information on how coordination of benefits works, review the Dental Expense Plan SPD or contact the carrier.

Coverage Options and Costs

Coverage Options

Understanding Your Dental Plan Options
Depending on your home ZIP code, you may have the following dental plan options:

Traditional option (available in all ZIP codes): This option pays 100 percent of reasonable and customary (R&C) charges for most covered diagnostic and preventive services. Other covered expenses are paid based on a schedule by region. You may visit any dentist to receive benefits.
Dental Maintenance Organization (DMO^®) option (if available in your home ZIP code)*: This option provides coverage through participating personal and specialty dentists with no deductible and lower out-of-pocket expenses for most services. This option covers 100 percent of certain basic and specialty services and 50 percent to 75 percent of others. To receive coverage, you must visit a dentist who participates in the Aetna DMO network.

* You will see only the Traditional option on the Your Benefits Resources (YBR) website; the DMO option will not appear as a coverage option on the YBR website, even if you are currently enrolled. To enroll in the DMO option, you must first enroll in the Traditional option (if you are eligible) and then call Aetna to enroll in the DMO option (if available in your home ZIP code).

The options vary by:

The deductible amount;
Annual benefit maximum amounts;
Coverage provided for certain dental services; and
The process for filing claims.

For more information about your dental coverage options, review the Dental Expense Plan SPD or contact the carrier.

If you need dental work costing over $200, you should determine, before treatment begins, what is covered and how much your dental plan option will pay. Please see “Predetermination of Benefits” in the Dental Expense Plan SPD, or contact the carrier.

Note: You will not receive an Aetna member ID card and you do not need one to receive care. However, if you would like to have a member ID card, you can print one out from the Aetna website.

To find a dentist in the DMO network:

Contact Aetna; or
Use the “Find a Dentist” link on the Your Benefits Resources (YBR) website.

Note: It is always a good idea to confirm with your dentist that he or she participates in your dental plan option before scheduling an appointment.

Changing Your Dental Plan Option
Once you are enrolled in the Traditional option, you may switch to the DMO (if it is available to you). You may switch back and forth between the Traditional option and DMO option at any time, but not more than once a month. To switch, call Aetna directly at:

1-800-220-5470 (if you are currently enrolled in the Traditional option); or
1-800-220-5479 (if you are currently enrolled in the DMO).

If you call by the 15th of the month, your change will become effective on the 1st of the following month.

Costs