Aetna Dental Inc. Dental Maintenance
Organization (DMO®)
  1. A retiree must live or reside in and an active employee must live, reside or work within the DMO service area to be eligible to enroll in the DMO plan. Please see the Service Area Map (499 KB / 1 page) and County Listings for a complete description of the service area.

  2. Emergency dental care services will be arranged by your selected general dentist for 24-hour emergency treatment. Emergency care is defined as dental services for palliative treatment only (emergency treatment of dental pain). Emergency care is also defined as the dental services administered in a dentist’s office, dental clinic or other comparable facility to evaluate and stabilize dental conditions of a recent onset and severity accompanied by excessive bleeding, severe pain or acute infection that would lead a prudent layperson, possessing average knowledge of dentistry, to believe that immediate care is needed.

    a) What is not considered an emergency?

     Some examples include, but are not limited to, the following:

    i. Lost filling.

    ii. Lost or loose crown or bridge.

    iii. Broken partial or full dentures.


    b) What if you have an emergency?

    i. Contact your selected participating DMO general dentist, who will arrange for  24-hour emergency coverage.

    ii. If your selected participating DMO general dentist or designated covering dentist is unavailable, contact us at 1-800-275-1794 for guidance or help in locating a participating DMO general dentist for palliative treatment.

    iii. If a participating DMO provider is not available or if you are out of the service area, you will be authorized to seek emergency palliative treatment from any licensed dentist. You must receive any needed follow-up treatment from your selected participating DMO general dentist.
    If you see a dentist for emergency dental care who does not participate in the DMO, and you get prior authorization from the DMO, the services provided for palliative treatment only will be covered at 100 percent of the usual and prevailing charge, minus the applicable patient payments under the plan. Palliative treatment is defined as emergency treatment of dental pain.

  3. We have complaint procedures to resolve member concerns and to settle differences in a fair and timely manner. Aetna Dental Customer Service works to resolve complaints informally with the member.

    If the results of the informal process are unsatisfactory, there is a formal procedure. Refer to the Complaint / Appeal Procedures for complete details of the complaint and appeal process.

    The DMO is prohibited from retaliating against any member or participating dentist for filing a complaint against the DMO.

  4. At the time your group coverage ends, you and any covered dependents have the right to convert to an Individual DMO Conversion Plan. The DMO must receive the application and first premium payment within 31 days of termination of group coverage. The Individual DMO Conversion Plan will take effect on the day after the group dental care coverage ends. Please call Aetna Customer Service at 1-800-275-1794 for more information.

  5. Covered procedures are listed in the "Dental Care Schedule". Plan member payments ("Patient Pays") are required at the time the service is rendered. The patient payments listed apply only when your selected participating general dentist performs services.

    If your participating general dentist cannot perform the covered dental procedure because of individual case circumstances or the severity of your condition, the general dentist may refer you to a participating specialty dentist for care.

  6. Services provided by a participating specialty dentist will be billed at 75 percent of the specialty dentist’s usual and prevailing charge.  Payment is required at the time the service is rendered.


    Specialty dentists have advanced training in the following types of services:

    Endodontics     The diagnosis, prevention and treatment of pathological conditions within the pulp chamber or apical area of a tooth root, including root canal treatment.

    Oral Surgery     Surgical procedures, including extractions, in and around the oral cavity and jaws.

    Periodontics     The examination, diagnosis and treatment of diseases affecting the tissues that support the teeth.

    Orthodontics     The detection, prevention and correction of abnormalities in the positioning of the teeth in their relationship to the jaws, including full braces.

    Pedodontics     Children's dentistry.

    Prosthodontics     The restoration and maintenance of function by replacement of natural teeth, including crowns, bridges and dentures.   


  7. We recommend that before you start any dental treatment, you and your participating general or specialty dentist discuss all charges relative to the services to be rendered.

  8. You should ask your participating dentist for a treatment plan that lists each specific service and applicable “Patient Pays” amount before you begin treatment.

  9. Please take your Aetna ID card with you when visiting your selected participating general dentist. If you have misplaced your card, please call Aetna Customer Service at 1-800-275-1794 to request a replacement.

    If you need to cancel a dental appointment, please call at least 24 hours in advance. Your dentist may charge you a fee for broken or missed appointments.

  10. This plan does not cover all procedures that could be performed by your selected participating general dentist. You are responsible for the full cost of dental procedures that are performed that are not included on the "Dental Care Schedule." In addition, the “Patient Pays” dollar amount specified for each procedure may not be your only cost for a given treatment, as the treatment may require more than one dental procedure.


  11. Exclusions and Limitations:
    1. Services that are not reasonably necessary for diagnosis and treatment.
    2. Services not listed in the "Dental Care Schedule."
    3. Treatment for malignancies or neoplasms.
    4. Prescription drugs are not covered by the DMO plan.
    5. A charge for a service not provided by a dentist. (This does not apply if the service is performed by a licensed dental hygienist under the direction of a dentist.)
    6. A charge for a service to the extent that it is more than the usual charge made by the provider for the same service when there is no coverage.
    7. A charge for a service to the extent that it is above the prevailing charge in the area for dental care of a comparable nature.
    8. A charge for any procedure not performed in a participating general dentist's or participating specialty dentist's office, except for emergency care and certain charges for nonparticipating dentists as provided in the coverage, including but not limited to hospitalization, outpatient centers, IV sedation and general anesthesia.


  12. Continuity of Treatment: If your participating general or specialty dentist terminates participation in the DMO and you are currently under active dental treatment, your dentist may continue providing care until the completion of the treatment in progress. If orthodontic treatment began before the participating general or specialty dentist’s termination, the dentist may continue to provide care throughout the course of active orthodontic treatment.

    13. Selecting a General Dentist

    You can view a list of general dentists participating in your area on the ERS website – www.ers.state.tx.us, select “Insurance,” “Dental,” then “Dental HMO” (Provider Look-up). Participating dentists are located in most, but not all, areas of Texas. A member shall not be required to travel more than 75 miles to obtain covered services from a participating general dentist.

    To be selected for the DMO network, dentists must complete our credentialing process and are recredentialed periodically. Each participating general dentist should be able to take care of most of your dental care needs.

    You should select a participating general dentist for yourself and your covered eligible dependents. For your convenience, you may choose a different participating DMO general dentist for each covered eligible member of your family. You may select a dentist by calling Aetna Customer Service at 1-800-275-1794, or you may e-mail us through the ERS website at www.ers.state.tx.us; select “Insurance.” “Dental,” then "Dental HMO" (Provider Look-up). Once you are on the Aetna DMO website, select "Aetna Customer Service" and follow the prompts. Please remember to contact Aetna Customer Service to change dentists, not ERS.

    Once enrolled, you and your family will receive family-style DMO ID cards. Each family ID card displays information for up to four covered family members in a single family. The employee and covered spouse each receive a family-style DMO ID card. Your selected participating general dentist's name, phone number and the Aetna Customer Service phone number, 1-800-275-1794, are printed on the front of the card.

    If you have any questions about the plan, Aetna Customer Service is available 8 a.m. to   5:30 p.m. CT, Monday through Friday.



    Switching Dentists

    You can switch participating general dentists monthly, no explanation required. Simply call Aetna Customer Service at 1-800-275-1794 or you may e-mail us through the ERS website at www.ers.state.tx.us; select "Insurance," "Dental," then "Dental HMO" (Aetna Customer Service). Once you are on the Aetna DMO website, select "Aetna Customer Service" and follow the prompts. A new family-style DMO ID card will be issued reflecting your new general dentist information. If you call the DMO by the 15th of any month, the change becomes effective on the first of the following month.


    Internet Address for DMO Participating Dentist List

    You can see the DMO Participating Dentist List on the ERS website at www.ers.state.tx.us; select “Insurance,” “Dental,” then “Dental HMO.”  Once in the Aetna website, select "Provider Look-up".

    Scheduling Appointments

    Once you have selected your participating general dentist, make an appointment as you would with any other dentist. Please mention that you are covered under the DMO plan for State of Texas and Higher Education Employees and Retirees when you call. At your first visit, please show your DMO ID card.

    Simplified Paperwork

    When using your selected participating general dentist, you will rarely have to fill out a claim form. In most instances, administration and paperwork are handled by the DMO. A patient signature verifying that the services were performed is usually all that is necessary.



    Patient Payments

    Many diagnostic and preventive dental care procedures performed by your selected participating general dentist require no payment on your part. A patient payment may be required for other dental care procedures. (See "Dental Care Schedule")   While enrolled in the DMO, if you choose to visit a dentist who is not your selected participating general dentist, dental services will NOT be covered by the plan. Therefore, you will be responsible for the full cost. The only exception is emergency palliative treatment specifically for the treatment of dental pain.

    Customer Service

    Our Customer Service department is available to assist you from 8 a.m. to 5:30 p.m. CT, Monday through Friday. Our Customer Service representatives can answer general questions or address concerns. In addition, these representatives can help in the selection of a new participating dentist or requests for new ID cards. You can reach Customer Service at 1-800-275-1794. The initial greeting provides access to instructions in either English or Spanish.

    If you need a translator, just request one. Aetna Customer Service has access to the AT&T language lines, which provide interpreters in 140 languages.

    A telecommunication device (TDD) for the deaf is available at 1-800-234-3730. Operating hours for this service are 8 a.m. to 4:30 p.m. CT, Monday through Friday.

    A computer system provides Aetna Customer Service instant access to your telephone and correspondence history. This eliminates the need for you to repeat your inquiry when speaking with more than one Aetna Customer Service representative. Since all departments share access to the system, one area can forward information to any other area in a matter of seconds.
Document Utilities
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Related Documents
The following documents are provided in Adobe PDF format.
Welcome Letter
Plan Overview
(152 KB / 1 page)
Employee Handbook
(1,036 KB / 45 pages)
Dental Summary of Coverage
(238 KB / 45 pages)
Dental Care Schedule
(684 KB / 4 pages)
Service Area Map
(499 KB / 1 page)
Dentist Selection Form
(18 KB / 1 page)
Dentist Nomination Form
(89 KB / 1 page)
Dental Educational Materials
Value Added Programs
Certificate of Group Dental Coverage

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