Orthodontic Care

Orthodontic care can help straighten crooked teeth and close gaps between the teeth. It can also fix a “bad bite.” Seeing an orthodontist when it is needed can help improve your dental health.

Just remember this: Not all dental plans include orthodontic coverage.* Orthodontic treatment has a lifetime maximum coverage amount, too.

If orthodontic care is included in your plan, here are some coverage facts you should know:

  • Get ready to start or continue care – Learn the steps to take if you are an Aetna Dental® benefits or dental insurance plan member and need orthodontic care. You will find tips on continuing your treatment if you switch from another carrier to Aetna Dental, too.
  • Explore how orthodontic coverage works – Perhaps you are starting a new job that offers Aetna Dental. Maybe you are currently working for a company that’s changing its plan to Aetna Dental. Explore the details of these two events.
  • View the answers to the most frequently asked orthodontic questions.
     

Get ready to start or continue care

Are you an Aetna Dental plan member starting or continuing orthodontic care? Here are some steps you should take:

  • Tell your orthodontist you are an Aetna Dental plan member
  • Ask for a pre-treatment estimate
  • Send us a copy with a completed claim form to:

Aetna Dental
P.O. Box 14094
Lexington, KY 40512

  • If you have a pre-treatment estimate given to you while you are covered under Aetna, please send us that copy.
  • If you have a pre-treatment estimate approved by your prior plan, please send us that copy instead.
  • When we receive your pre-treatment estimate, we will send you coverage details specific to your plan.
     

Your first claim

The first claim your orthodontist submits has details that will help us determine your benefits, too. Your first claim form must include:

  • Treatment type
  • Date braces were or will be put on teeth
  • Total treatment cost
  • Estimated number of treatment months
  • American Dental Association treatment code

If you had orthodontic care under a different dental plan, your claim must also include your prior plan’s:

  • Explanation of Benefits notice
  • Deductible, copay/coinsurance amounts
  • Maximum coverage amount
  • Amount paid to date
     

Explore how orthodontic coverage works

New to your job and have an Aetna Dental plan with orthodontic coverage? Here are some facts you should know:

  • You are eligible for orthodontic coverage that starts after your dental plan begins.
  • Some plans have a work-in-progress exclusion. That means you are not covered for treatment that starts before your dental plan begins. Check your plan documents, or ask your human resources specialist if your plan has a work-in-progress exclusion.

Currently working for a company that is switching to an Aetna Dental plan with orthodontic coverage?

  • If your orthodontic care was covered by your prior dental plan and started before your Aetna coverage begins, we will continue to cover your treatment
  • Your coverage amount depends upon what was paid by your prior dental plan and the number of treatment months still remaining
  • No benefits are available for treatment that has ended
  • You may be covered up to your lifetime plan maximum if your treatment starts after your plan begins

*Check your plan documents, or ask your human resources specialist if orthodontic coverage is included in your plan.

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