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Choose a primary care dentist who participates in our network. Each covered family member can select their 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.
Aetna Dental members don’t need a member ID card to get dental care. When you go to or call the dentist, tell the office staff that you have Aetna Dental DMO. They will be able to verify your coverage.
You can view and print your ID card from your member website. Signing up is simple and free.
You can also view and share your digital ID card from the Aetna Health℠ app. Download the free app today. Just go to the Apple App Store or Google Play Store.
Your plan may have a coordination of benefits provision. If so, we will confirm which plan has primary responsibility for claim payment. If we have primary responsibility, we will pay as the primary payor. If not, we will pay as the secondary payor.
The primary payor pays claims as it normally does. They do so as if there is no secondary payor. The secondary plan acts like a supplement to the primary plan.
Your benefits don’t double if you are enrolled in two dental plans. This means if you have two plans that cover two cleanings per year, you don’t have four cleanings per year.
There are several types of coordination of benefits provisions. They may differ by plan. If you need more information, contact Member Services. You can reach them using the number on your ID card.
Yes. Every enrolled family member may select their own primary care dentist. We encourage you to select a primary dentist at the time of enrollment.
The PCD has primary responsibility for managing your dental care. Each DMO® member must select a PCD. You may choose a new one once a month.
To change your PCD, log in to your member website. Or call Member Services at the number on your ID card.
If you choose a new PCD on or before the fifteenth 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 sixteenth 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. Log in to your member website first to get personalized results. Search for a dentist by name, specialty, ZIP code or the number of miles you are willing to travel.
Unless required by state law, a pediatric dentist is considered a specialist. They aren’t a PCD. Members can’t choose a pediatric dentist as their PCD.
Most PCDs treat children and can refer members to a pediatric dentist, if necessary.
Orthodontic treatment from a participating provider doesn’t require referrals. For other specialists, a referral may be necessary. If so, the primary care doctor will arrange it.
A dentist's reimbursement is a combination of:
- The amount we pay the dentist
- The member’s copay/coinsurance amount
We have an arrangement with our DMO® providers. It sets what they can charge for covered services. What you pay will be based on a percentage of those charges (coinsurance). Or it will be a flat dollar amount (copay).
The DMO plan doesn’t have any deductibles or annual maximums.
Please contact Member Services. You can reach them at the number on your ID card.
You must contact us. We need to authorize the use of a different provider before treatment.
Check your Aetna® Summary of Benefits. It describes the services you have coverage for under your plan. You can get a Summary of Benefits from your employer that provides your insurance.
Yes, but some plans may limit the benefit to certain teeth. Contact Member Services if you have questions.
You may not have coverage to replace teeth that were lost or extracted before your coverage began. This applies to services for:
- First-time dentures
- Fixed or removable bridges
For more details, review your plan documents. Or you can contact Member Services.
Please see your plan documents. Or call Member Services for coverage details.
Yes. Some services have this type of restriction. Check your plan documents or call Member Services for details.
If you had coverage under a previous insurance carrier, you’ll have coverage for certain services 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
We may not cover services you’ve received without coverage. You can see if your plan has a work-in-progress exclusion. To find out, just call Member Services.
Some problems may need more than one service to fix. If so, most services will be considered separately.
Have your dentist send a pretreatment estimate (predetermination) to us. This will let you and the dentist know what the benefit will be if the service is done. You or your dentist may also call Member Services. You can reach them at the number on your member ID card.
Predeterminations may not be available in all states. Please see your plan documents. Or contact Member Services for coverage details.
Please see your plan documents. You can also contact Member Services to determine if they are eligible under your DMO® plan.
Periodontal maintenance is for patients who’ve previously had periodontal treatment. DMO plans require a surgical periodontal history.
*Illinois members: State laws vary with regard to out-of-network benefits. In Illinois, DMO plans provide limited out-of-network benefits. However, in order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. Illinois DMO is not an HMO. Virginia members: In Virginia, DMO is called DNO (Dental Network Only). DNO (Dental Network Only) in Virginia is not an HMO. To receive maximum benefits, members must choose a participating primary care dentist to coordinate their care with in-network providers.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna).
This material is for information only. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change.