There are three basic types of dental benefits and dental insurance plans:
Here's a chart to help you learn the differences:
| DMO | Dental PPO or PDN | Dental Indemnity | |
| Plan description | A lower-cost dental benefits plan that gives you cost-effective care through a primary care dentist (PCD). You get the advantage of building a relationship with your PCD. | Visit any licensed dentist to receive benefits. You will typically enjoy lower costs if you choose a dentist who participates in our PPO/PDN network. There is never a need for a referral. | The freedom to visit any licensed dentist, anywhere in the country. No need to choose a PCD. There is never a need for a referral. |
| Plan options | Copay – you pay a set dollar amount at the time of service; or Coinsurance – you pay a percentage of covered expenses at the time of service. | Coinsurance – you pay a percentage of covered expenses at the time of service. | Coinsurance – you pay a percentage of covered expenses at the time of service. |
| Primary Care Dentist election | Yes – Call the dentist to ensure he or she is accepting new patients. | Not required | Not required |
| It’s easy to find a participating dentist. Just visit DocFind®, our online directory at http://www.aetna.com/. Or call Member Services at 1-877-238-6200. | |||
| Office visit copay – the amount you pay each time you visit the dentist for any procedure. | $0 to $15 depending on your plan. | None | None |
| Deductible – the amount you pay before your plan pays. | None – There is just a copay to pay. You do not have a plan deductible. | Yes – There is a deductible for procedures not covered at 100%. That means you pay a dollar amount before the plan starts to pay. | Yes – There is a deductible for procedures not covered at 100%. That means you pay a dollar amount before the plan starts to pay. |
| Annual maximum – the maximum amount your plan will pay out in a plan year. | None – Aetna DMO plans do not have an annual maximum limit. The plan continues to pay benefits for covered procedures throughout the plan year. | Yes – There are limits to how much Aetna will pay in benefits for covered procedures in a plan year. | Yes – There are limits to how much Aetna will pay in benefits for covered procedures in a plan year. |
| Referrals – the primary care dentist directs you to seek dental care from another dental professional. | Referrals are required, except when you visit an orthodontist in our DMO network. | None required | None required |
| Procedures NOT covered by the plan | You are responsible for the cost of procedures not covered by your plan. | You are responsible for the cost of procedures not covered by your plan. And remember this: Participating PPO and PDN dentists offer discounts on procedures not covered by your plan. | You are responsible for the cost of procedures not covered by your plan. |