David: Hi, I’m David, from Aetna, and let me be the first to say, congratulations! You’ve hit the jackpot!
The dental plan jackpot!
Fine, it may not be the jackpot most people would like to hit, if they were to hit a jackpot, but let me explain…
Take a look at this handy Dental Benefits & Insurance Luck-o-Meter: Some companies don’t offer dental benefits or insurance- that’s not lucky at all.
Other companies do offer a dental plan to their employees, maybe Aetna’s Dental Preferred Provider Organization, or PPO.* It offers traditional dental insurance coverage, with an in-network option that can help you save more money— that’s pretty lucky.
Some other companies offer two quality dental plans- say, the Dental PPO and Aetna’s Dental Maintenance Organization**. The DMO®** benefits and insurance plan helps make coverage affordable, by coordinating care through an in-network primary care dentist. The very lucky employees of these companies get to choose which one of the two plans they’d like for the coming year.
But, you-- oh lucky, lucky, lucky you—your employer offers Aetna’s Freedom of Choice.
Freedom of Choice is two plans in one: you get Aetna’s Dental PPO and DMO**, but you’re not locked into one or the other for the entire year; you can switch back and forth between the two plans as you see fit. For example, start the year off in one, then switch to the other at some point, maybe switch back later on—you can change plans once a month… or stay with one the whole year.
Let me give you a better idea of how Freedom of Choice works…
Think of it this way: The Dental PPO is a car, and the DMO** is a bus pass… a bus pass for the coolest bus ever!
With the PPO, you can drive anywhere- see any dentist you’d like, at any time. However, the car only comes with one tank of gas: your annual maximum benefit. Once you’ve used it all, the Dental PPO won’t pay any more of your costs. By using an in-network dentist, you’ll stretch that tank of gas out, but you should still keep an eye on the gas gauge.
The DMO bus, on the other hand, sticks to a route and only stops at those dentists who are in Aetna’s DMO network. But, this bus route is extensive, with over 81,000 stops- er, available dental practice locations***. There’s no deductible; plus, your pass never expires- there’s no annual dollar maximum- so you have coverage all year long.
And, because you have Freedom of Choice, you get the bus pass and the keys to the car.
You could start the year by trying out the DMO- working with a dentist from the DMO network and enjoying the plan’s lower out-of-pocket costs- then decide that you’d rather see a different dentist who isn’t in the DMO. Switch to the PPO, and see whichever dentist you like, in-network or out—just keep in mind that an in-network dentist will stretch your benefit dollars further.
Hit the annual maximum benefit for the PPO? You can switch back to the DMO, and continue to be covered for the rest of the year.
Or, maybe you start the year in the PPO, then find out your daughter needs braces. You can switch to the DMO, select a DMO network dentist, and take advantage of the higher orthodontic coverage the DMO provides.
The point is, you’re free to choose the plan that works best for you, when it works best for you. Switch plans by the 15th of one month, and be on your new plan effective the first of the next. All you have to do is call Member Services or visit Aetna.com—now also available on your smartphone.
So, although you may not be lucky enough to avoid the occasional cavity, thanks to your employer and Aetna, you do have Freedom of Choice.
*In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN).
** In Illinois, DMO plans provide limited out-of-network benefits. However, in order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. Illinois DMO is not an HMO.
***These facts are as of December 2013 based on Aetna provider data.
Dental benefits and dental insurance plans are offered, underwritten and/or administered by Aetna Health Inc., Aetna Dental Inc., Aetna Dental of California Inc. and/or Aetna Life Insurance Company (Aetna), and in TX, by Aetna Dental Inc. In TX, the Dental PDN insurance plan is underwritten and/or administered by Aetna Life Insurance Company (Aetna). Each insurer has sole financial responsibility for its own products.
If you require language assistance from an Aetna representative, please call the Member Services number located on your ID card, and you will be connected with the language line if needed; or you may dial direct at 1-888-982-3862. (140 languages are available. You must ask for an interpreter.) TDD 1-800-628-3323 (hearing impaired only).
Si requiere la asistencia de un representante de Aetna que hable su idioma, por favor llame al número de Servicios al Miembro que aparece en su tarjeta de identifi cación y se le comunicará con la línea de idiomas si es necesario; de lo contrario, puede llamar directamente al 1-888-982-3862. (140 idiomas disponibles. Debe pedir un intérprete.)
TDD-1-800-628-3323 (sólo para las personas con impedimentos auditivos).
This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Rates and benefits vary by location. Dental information programs provide general dental information and are not a substitute for diagnosis or treatment by a dentist or other dental care professional. Dental providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to dental services. Dental benefits and dental insurance plans contain exclusions and limitations. Not all dental services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and/or group size and are subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com.
Policy forms issued in OK include: GR-9/GR-9N. GR-23 and/or GR-29/GR-29N.
© 2014 Aetna Inc.
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