Network Option Dental Plans (PPO)

A flexible dental plan with no need for referrals

Preferred Provider Organization (PPO)* dental insurance plans provide flexible dental health plan options.

child brushing his teeth child brushing his teeth

Plan features

  • Members can visit any licensed dentist without a referral.
  • The plan provides coverage for preventive, basic and major services.**
  • The contracted rates with network dentists are often much lower than their regular fees. This may save members money by staying in our network.

 

Plan options

  • Choice of deductibles, coinsurance levels, maximums and benefits levels.
  • Choose from self-funded or fully insured options.
  • Options include the Aetna Dental Care RewardSM plan and the Aetna DentalFund® plan.

 

The most common structures behind our plans

  • Passive plan – Deductible and coinsurance amounts are the same for in-network and out-of-network services.
  • Active plan – Deductible and coinsurance amounts are different for in-network and out-of-network services.
  • PPO Max plan – Members who use non-participating dentists will be reimbursed based on the standard negotiated fee only and may be balance-billed by the dentist.

 

Cost savings

  • Offer a PPO plan to those who pay 50% or more of the premium.
  • Ask about our low cost PPO plan, Aetna Dental Preventive CareSM.
  • Our PPO II network*** is a vendor-based network that adds thousands more PPO dental practice locations nationwide. That can mean greater access to dental services at contracted rates.

 

PPO plans at a glance

PPO dental plans

Networks

Plan options

Funding

PCD required

Plan maximum

PPO
Members can visit any licensed dentist. They may pay less if they choose a dentist from our large PPO network.

PPO, Aetna Dental PPO II (vendor-based)

Deductible and/or coinsurance

Fully or self-insured

No

Yes

Aetna Dental Care Reward
Rewards members the next plan year for visiting a dentist for preventive care during the current plan year.

PPO, Aetna Dental PPO II (vendor-based)

Deductible and/or coinsurance

Fully or self-insured

No

Yes

Aetna Dental Preventive Care
Members get preventive care and some diagnostic services covered at 100% in one cost-saving plan when they visit a network dentist.

PPO, Aetna Dental PPO II (vendor-based)

No deductible or copay for preventive care and diagnostic services

Coinsurance applies

Fully or self-insured

No

Yes

Aetna DentalFund PPO
Combines base dental coverage with a fund to help employees pay for their dental expenses. The fund can offset their eligible out-of-pocket costs, up to the fund balance. Leftover monies roll over to the next plan year. Contributions are tax-deductible.

PPO, Aetna Dental PPO II (vendor-based)

Deductible and/or coinsurance

Fully or self-insured

No

Yes

The choice of two plans

 

Networks

Plan options

Funding

PCP required

Plan maximum

Freedom-of-Choice
One premium, two plans. Employees can switch each month between a DMO and either a dental PPO or indemnity dental insurance plan option that the employer chooses.

DMO and PPO, Aetna Dental PPO II (vendor based)

DMO:
Fixed copay, coinsurance, no deductible

DMO:
Fully insured

DMO:
Yes

DMO:
No

Dual Choice
Two premiums/rates, two plans. Employees can select either an Aetna DMO or dental PPO or indemnity plan at enrollment (no monthly switch).

No network for indemnity

PPO and indemnity:
Deductible and/or coinsurance

PPO and indemnity:
Fully or self- funded

PPO or indemnity:
NO

PPO or indemnity:
Yes

*In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN).

**Plan options may vary by state.

***Included with fully insured plans. Optional with self-funded plans.

Dental insurance plans are offered, underwritten and/or administered by Aetna Life Insurance Company (Aetna).

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 health care professional. 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 group size and are subject to change. 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. 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 Oklahoma include: GR-9/GR-9N, GR-23 and/or GR-29/GR-29N.

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