aetna dental ppo coverage 2022aetna dental ppo coverage 2022

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. 4. . That would not be made if you did not have coverage. Others have four tiers, three tiers or two tiers. You will receive the discount off the providers usual and customary fees when you pay. are covered at 100% on most plans. Crown, inlays and onlays, and veneers unless for one of the following: The information you will be accessing is provided by another organization or vendor. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 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 school has chosen a plan that makes it easy to keep your smile. SBBC now offers the option of four dental plans available from three dental carriers. Includes PPO, HMO, HMO-POS medical plans with or without drugs. Compare our plans and find the coverage that's best for you. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Language services can be provided by calling the number on your member ID card. Copyright 2015 by the American Society of Addiction Medicine. 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. Click the Register button to get started. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. CPT only copyright 2015 American Medical Association. Get lower rates when you go to a dentist thats in your PPO network. *** Terms and conditions: Bit.ly/2nlJFYG. Pricing starts at $20 in most regions, and also includes: No waiting periods Inclusive plans. 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). With our HMO-POS plans, you can enjoy all the benefits of receiving medical care through a network provider. the difference in cost between the approved less costly service and the more costly covered service. If you need a PDF document in an accessible format, you can request it directly through"Contact Us" here or at the top of the page. Claims must be submitted within 365 days of the date you received the service. This site has its own log in. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-877-698-4825, is the Discount Medical Plan Organization. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Once youre a member, heres how you can connect: 1. 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. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. CPT is a registered trademark of the American Medical Association. Your Payer Express log in may be different from your Aetna secure member site log in. 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. 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. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Switch by the 15th day of the current month. This search will use the five-tier subtype. * In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). 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. Visit a dentist in the Aetna Dental PPO* network. CPT is a registered trademark of the American Medical Association. Surgical removal of impacted wisdom teeth when only for orthodontic reasons 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. Taking care of your teeth is as an important part of taking care of your health. 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 Your dental plan may have yearly and lifetime limits on coverage. 2023 DentalPlans.com, Inc. All Rights Reserved. Yes, I'm a memberNo, I'm looking for a plan. Aetna Health members, log-in securely to your account to access all of your health and benefits information, or get your user name and/or password if you've forgotten it. Aetna MAplans offer three types of dental benefits:network,direct memberreimbursementallowanceand optional supplemental benefits. Get the Aetna Health app by texting GETAPP to 90156 for a link to download the app and create an account. Choose a PCD from our network**: Use ourprovider search toolto find one. Network dentists offer special rates for covered services. Aetna Dental Direct insurance plan is offered by Aetna Life Insurance Company (Aetna). Aetna Medicare Advantage plans provide benefits that original Medicare does not. 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. The information you will be accessing is provided by another organization or vendor. 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. Not available in many states. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 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. 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. Enjoy discounts on hearing aids, exams and hearing aid batteries mailed to your home. 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. 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. 2022 Aetna Dental 2 Enroll at www.BENEFEDS.com . 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. CPT only Copyright 2022 American Medical Association. Aetna Student Health Agency Inc. is a duly licensed broker for student accident and health insurance in the Commonwealth of Massachusetts. Alternate Treatment Rule First time users can also sign up and register for an account. No fee schedules, basic unit, relative values or related listings are included in CPT. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. 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. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. 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). Click here to review plans with a $0 deductible. 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. Studies show that a healthy mouth helps you avoid health problems in the body, too. 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). If you do not intend to leave our site, close this message. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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). - It is treatment for decay or traumatic injury and teeth cannot be restored with a filling material Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. It may be different from your Aetna secure member site log in. All services deemed "never effective" are excluded from coverage. You can also download it from the App Store or the Google PlayTM store. 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. 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. Or log in to your member account to submit the form online. Network dentists offer special rates for covered services. You are now being directed to the CVS Health site. You can find a network provider by logging in as a member and going to our provider directory. Get the coverage you need to keep your mouth, teeth and gums 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. The plan offers both network (DMO) or out-of-network (PPO) coverage. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). You are now being directed to CVS Caremark site. Cancelled or missed appointment charges or charges to complete claim forms. And withAetna MA plans, you have a variety of options to make it more affordable and easierto keep up withyourdental care. Deductible: the dollar amount some plans require you to pay for services before coverage starts. Check your benefits summary, so youll know what to pay. How to enroll: Links to various non-Aetna sites are provided for your convenience only. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. Others have four tiers, three tiers or two tiers. 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. Program providers are solely responsible for the products and services they provide. Rates start at $7.99 a month. 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 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. 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. Vision and hearing at no additional cost. Im turning 65 or just starting to explore Medicare. The employee pays the remainder through payroll deduction Premiums are deducted on a pre-tax basis Contact Information at Aetna Customer Service 1-877-238-6200 or www.aetna.com About the Plan Aetna Dental Summary - Effective January 1, 2023 Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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 is only a partial, general description of plan or program benefits and does not constitute a contract. You may also be required to pay a portion of the costs. If youre submitting your form online, be sure to attach your receipt to your submission. We encourage you to check with your participating provider prior to beginning treatment.

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