Freedom of Choice dental plan members can switch between an Aetna DMO® plan* or an alternate plan (either PPO, PDN** or Indemnity plan) on a monthly basis. Here's how orthodontic coverage works:
Switching from DMO to PPO/PDN or Indemnity plan
- Benefits are subject to the new plan's orthodontic maximum
- If the new plan doesn't cover orthodontia, no benefits can be paid
- If you switch back to the DMO plan, the months you were covered under the Indemnity or PPO/PDN plan will be deducted. That means no benefit is paid for that time period.
Switching from PPO/PDN or Indemnity to a DMO plan
- DMO plan benefits are not subject to the Indemnity or PPO/PDN plan maximum. DMO plan orthodontic benefits are based on a 24-month lifetime plan maximum.
- When you switch to a DMO plan, benefits for any remaining orthodontic treatment will be considered as one course of treatment limited to 24 months.
* 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.
**In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN).