Dental Maintenance Organization (DMO) FAQs for Individuals and Families

Choose a primary care dentist who participates in our network. Each covered family member can select his or her own.

• Depending on your plan, you may pay for dental care in one of two ways: 
  • Copay — You pay a set dollar amount
  • Coinsurance — You pay a percentage of covered expenses
• There are no deductibles or annual dollar maximums.
• Your dentist usually will submit your claims for you.

Aetna Dental members do not need a member ID card to get dental care. When you go to the dentist, tell the office staff that you have Aetna Dental and they will verify your coverage.

You can view and print your ID card from your member website. Signing up is simple and free. Register and log in today at Aetna.com.

You can also view and share your digital ID card from the Aetna Health℠ app. Download the free app today at the App Store or Google Play.

Register and log in at Aetna.com

Learn more about the Aetna Health℠ app

If your plan has a coordination of benefits provision, we confirm which plan has primary responsibility for claim payment. If we have primary responsibility, we pay as the primary payor. If not, we pay as the secondary payor.

The primary payor pays claims as it normally would, as if there were no secondary payor. The secondary plan acts like a supplement to the primary plan.

If you are enrolled in two dental plans, benefits are not additive. For example, if each plan covers two cleanings per year, you are not entitled to four cleanings per year.

Please note that there are several types of coordination of benefits provisions. They may differ by plan. If you need more information, please contact Member Services using the number on your ID card.

Yes. The PCD has primary responsibility for managing your dental care. Each DMO member must select a PCD. You can switch your selection as frequently as once per month.

To change your PCD, log in to your secure member website, or call Member Services using the number on your ID card.

If you choose a new PCD on or before the 15^th of the month, the change will go into effect on the first day of the following month. (For example, if you change your PCD on April 15, the change will take effect May 1.)

If you choose a new PCD on the 16^th day of the month or later, the change will go into effect two months afterward. (For example, a change made on April 16 will take effect June 1.) 

You can find a network dentist with our online directory. For personalized results, first log in to your secure member website. Search for a dentist by name, specialty, zip code or the number of miles you are willing to travel. 

Log in to find a dentist who accepts your coverage

Find a dentist using our public site

Unless required by state law, a pediatric dentist is considered a specialist, not a PCD. So members cannot choose a pediatric dentist as their PCD. 

Most PCDs treat children, and can refer members to a pediatric dentist if necessary. 

Referrals are not required for orthodontic treatment from a participating provider. For other specialists, the PCD will arrange a referral if it is necessary.

Dentist's reimbursement is a combination of what Aetna pays the dentist and the member’s copay/coinsurance amount.

Aetna has an arrangement with our DMO providers that sets what they can charge for covered services. What you pay will be based on either a percentage of those charges (coinsurance) or it will be a flat dollar amount (copay).

The DMO plan does not have any deductibles or annual maximums.

Please contact Member Services at the number on your ID card.

Your must contact us before treatment so we can authorize the use of a different provider.

Your Aetna Summary of Benefits describes the services that are covered under your plan. You can get a Summary of Benefits from the employer that is providing your insurance. 

Yes, but some plans may limit the benefit to certain teeth. Contact Member Services if you have questions.

If the teeth were lost or extracted before your coverage began, then services to replace them may not be covered by your plan. This applies to first-time dentures, fixed or removable bridges, and implants.  For more details, contact Member Services or review your plan documents.

Please see your plan documents or contact Member Services for coverage details.

Yes. Some services have this type of restriction. Please see your plan documents or contact Member Services for details.

See our Orthodontia FAQs

If you were covered under a previous insurance carrier, certain services will be covered by that plan even after your Aetna coverage begins. This is called an extension of benefits provision. These services include:

• Crowns and fixed bridgework, when the teeth were prepared before your Aetna coverage began
• Appliances (such as dentures), when the impression was taken before your Aetna coverage began
• Root canal therapy, when the tooth's pulp chamber was opened before your Aetna coverage began

If you had no coverage and started treatment for a service, that service may not be covered under your Aetna plan. Contact Member Services to see if your plan has a work-in-progress exclusion.

If more than one service is needed to fix a problem, most services are considered separately. 

Have your dentist send a pretreatment estimate (predetermination) to us. This will let you and the dentist know what the benefit would be if the service were done. You or your dentist may also call Member Services at the number on your member ID card.

See our FAQs about oral surgery

Periodontal maintenance is for patients who have previously been treated for periodontal disease.  DMO plans require a surgical periodontal history.