Skip to main content

Group dental benefits and insurance plans

With Aetna Dental® plans, you get more than ancillary products. You get a menu of plan choices to protect members’ whole health, for a whole-healthy business.

Explore dental plan choices

 

Aetna Dental offers one of the largest PPO and DMO networks in the industry with significant discounts for our members. Check out these affordable plan options.

Dental Maintenance Organization (DMO) plan

Guidance and great savings

With Aetna Dental DMO*, you get quality dental coverage that fits everyone’s budget. An in-network primary care dentist (PCD) guides members’ care. There’s no paperwork or hassles.

Plan features:

  • In-network PCD required
  • Lower premiums
  • Referrals required for specialty care (except orthodontia) 
  • No deductibles, claims or annual maximums
  • No lifetime limit for major services

Preferred Provider Organization (PPO) plan

Freedom to always choose

If your members like freedom, they’ll love Aetna Dental PPO. They can visit any in-network dentist to keep rates lower or choose to see any dentist. There are no referrals required either way.

Plan features:

  • Freedom to see any licensed provider
  • Lower costs for staying in network
  • No PCD or referrals required
  • Higher premiums than DMO
  • Deductibles and yearly limits apply

Indemnity plan

Any licensed dentist, anywhere

With Aetna Dental Indemnity, there’s no need to choose a PCD. Members can visit any licensed dentist in the country and pay their bill on the spot. To get reimbursed, they may need to file a claim.

Plan features:

  • Freedom to visit any licensed dentist
  • Cost share paid directly to the dentist
  • No referrals required
  • Great for fully insured and self-funded customers
  • Annual and lifetime coverage limits may apply

 

Freedom of Choice plan

Flexibility for changing needs

With Aetna Freedom-of-Choice, members can switch between two plans — with two networks — to fit their needs. They can choose our DMO for the simplicity and savings of in-network, PCD-guided care. Or choose our PPO or indemnity plan to visit any provider.

Plan features:

  • Flexibility to switch plans throughout the year, as often as every month
  • One convenient price
  • Freedom to visit providers in or out of network
  • No PCD or referrals required (PPO & Indemnity)

*For DMO plans, some states allow limited benefits when members go out of network for covered services. In Illinois, DMO plans provide limited out-of-network benefits, but to receive maximum benefits, members must select and have care coordinated by a participating PCD. In Illinois, the DMO plan is not a health maintenance organization (HMO). In Virginia, the DMO plan is known as the Dental Network Only plan (DNO). DNO in Virginia is not an HMO. In California, dentists may refer members to out-of-network dentists for some services.

Bringing value to your dental plan

Mobile dentistry

We’re bringing the dentist to employees with a mobile or in-office clinic.

  • There’s no cost to you.
  • Services may include preventive care such as cleanings, X-rays, exams and restorative procedures such as fillings and crowns.
  • Services vary by provider.
     

Alternative orthodontics

We’re partnering with online vendors to offer convenient, certified orthodontic solutions.

  • Providers oversee remote treatment and guidance from beginning to end.
  • There’s no need for in-person appointments.
  • Supplies are delivered directly to home from Candid® or SmileDirectClub®.

Teledentistry

We’re working with network providers to offer teledentistry services to give members more choice and convenience.

  • Members can connect with dentists through virtual visits using technology such as Facetime or Skype.
  • Dental providers can offer routine and/or oral evaluations, answer questions, give advice, prescribe medicine and refer patients to specialists, if needed.
  • Teledentistry helps avoid unnecessary travel and costs, emergency room visits or time away from work or school.

Member tools and resources

Taking charge of health and benefits is easier with the Aetna member website.

After logging in, your members can:

  • Pull up their ID card
  • Search for network dentists by name, specialty or procedure
  • View dental plan summary and what’s covered
  • Track spending and progress toward meeting deductible
  • View and pay claims
  • Get cost estimates before receiving care*
  • Access discounts on additional services and products

*This service is available only for dental members on a PPO plan.

Pairing dental and medical for powerful health

At Aetna we love to see our members smile.  Because we know that a healthy happy smile is a window into overall health. 
 

That’s why when we saw the staggering costs of some of the most common health conditions, we knew it was time to take a deeper look.
 

We teamed up with Columbia University to research the relationship between oral health and high-cost health conditions like heart disease, diabetes, and some pregnancies.
 

And we found a big connection, so we did something about it and launched our first Aetna Dental Medical Integration Program in 2007. 
 

Through it we link our member’s dental and medical data to find out if they have conditions that can benefit from regular or additional dental care. 
 

We automatically reach out to those who haven’t seen a dentist recently and encourage them to schedule a visit.  Not every carrier has this kind of integration and that’s because Aetna has been at the forefront of this approach to care.
 

We also provide enhanced benefits at no extra cost to the member.  And the results speak for themselves.  Members who are in our Aetna Dental Medical Integration Program experience significantly better health outcomes than those who weren’t. 
 

With this program we’re helping to drive healthier outcomes and helping to lower health care costs.  Which is something to smile about.

Pairing dental and medical for powerful health

Studies show that good dental care can lead to better overall health.* Not only do dental problems cause pain and lost time, but they can also lead to serious health problems. That’s why the Aetna Dental Medical Integration program is so valuable.
 

This program helps us easily identify members with high-risk conditions who may benefit from extra dental care. By using our unique ability to integrate dental and medical claims data, we’re able to reach out to members to help them seek the right care sooner, for better overall health.

You’re listening to Connections Matter- How integrating medical and dental data improves member health and lowers costs for employers.
 

Table of contents

Chapter 1: Executive summary

Chapter 2: Oral health is health: Chronic disease is widespread – and costly

Chapter 3: Solutions on the horizon: Why integration matters – for members and employees

Chapter 4: Aetna dental/medical integration program details

Chapter 5: The bottom line
 

Chapter 1: Executive summary
 

Quote - “By integrating our medical and dental databases, we can coordinate care and provide our members with better overall value, and our plan sponsors with a healthier workforce.” - Mary Lee Conicella, Aetna’s Chief Dental Officer.”
 

The mouth is a window into the health of the body — and the benefits of maintaining good dental hygiene extend far beyond the teeth and gums alone.
 

In fact, oral health has a major impact on overall health, medical costs and quality of life. However, for many, the prospect of achieving or maintaining an optimal quality of health through a combination of care, that includes both dental and medical, is out of reach.
 

One third of Americans do not have dental insurance, and low-income Americans have even lower rates of access to dental insurance. Then consider that nearly half the adult population in America suffers from periodontal disease — a chronic inflammatory condition that can result in bone loss, loose teeth and painful, swollen gums.
 

To make matters worse, periodontal disease affects more than just oral health: it has been linked to physical conditions like diabetes, heart disease and strokes, and mental-health issues like worsening cognitive impairment.
 

Insurance carriers and plan sponsors can — and must — play a leading role in solving these issues. But many plan sponsors may not know where to start – or that there are even solutions available. That’s where we come in.
 

This whitepaper will demonstrate the powerful impact oral health has on overall health and how integrating dental and medical claims data gives employers access to a no-cost solution that boosts member health and delivers cost savings.
 

Chapter 2: Oral health is health
 

Oddly enough, for decades, oral care hasn’t been included in primary care — even though oral health issues can cause severe pain and, in some cases, even death. On top of that, poor oral health can contribute to mental health problems and even adversely affect employment prospects.
 

The silver lining is that all these potential outcomes can be avoided. Simply because dental disease is almost entirely preventable. Taking greater measures to understand how oral health impacts overall health, medical costs and quality of life is key to understanding how we can begin to unlock the transformative power of an evolving health system.
 

The link between oral health and chronic diseases
 

This relationship between dental and overall health is nothing new. The connection between oral health and conditions like diabetes, heart disease, strokes and pregnancy complications has long been studied.
 

However, there was little new information on this possible link and its related costs until Aetna and Columbia University conducted three joint studies.
 

In a groundbreaking study, published in 2006, researchers identified a correlation between dental health and three conditions: Diabetes mellitus coronary artery disease, and cerebrovascular disease.
 

They concluded that those who had dental care across a two-year period had significantly lower retrospective risk scores than those with no dental care at all.
 

Subsequent studies published in 2011 and 2018 made the connection between having dental care while pregnant and lower preterm delivery rates and incidences of low birth weight. Both studies took advantage of the extensive Aetna dental and medical plan databases.
 

Chronic disease is widespread — and costly
 

Any relationship between better oral health and improved overall health merits attention, given the huge numbers of Americans at risk — especially when it comes to heart disease and diabetes.
 

In the United States, one out of every four deaths is caused by heart disease, with coronary heart disease contributing to 655,000 deaths per year. The prevalence of cardiovascular disease has resulted in astronomical costs, costing the U.S. $400 billion a year — a figure projected to triple by 2030.
 

Like heart disease, diabetes is also epidemic in our society — the American Diabetes Association reports that over 34 million U.S. adults and children have the disease. And, like heart disease, it is costly, with a yearly economic burden of over $327 billion in the U.S.
 

There are also indirect costs. Lost productivity accounts for an estimated increase from $172 billion in 2010 to $276 billion by 2030.
 

As these chronic illnesses take their toll on our society — and economy — some people may wonder what the solutions are. What can be done to remedy these sobering issues? And who should take on that responsibility?
 

Chapter 3: Solutions on the horizon
 

Health care practitioners and insurance carriers, like Aetna, are working to slow this epidemic of chronic disease — and integrating dental and medical care is a good start. More and more dentists are collaborating with physicians — and patients are reaping the benefits.
 

Meanwhile, researchers are examining other chronic conditions to see if dental health can play a role in boosting overall health, while helping to reduce medical costs.
 

Employers also play a pivotal role in this continued collaboration. By working with insurance carriers, employers have access to a no-cost solution to help them recoup lost productivity and lower their expenses.
 

The Aetna integration of dental and medical care is a groundbreaking component of this whole-person treatment. Dentists, physicians, other medical practitioners, insurance carriers and employers all have roles to play. Together we can enhance the effectiveness of this integration.
 

Why integration matters — for members and employers
 

Members are healthier.
 

The Aetna Dental/Medical integration program (DMI) has been turning research into real-world results for over a decade. As such, millions of at-risk members have been identified, with major outreach initiatives being provided. The result: We’ve helped to improve the health of up to one out of every five members.
 

Numbers matter in research, and larger studies tend to provide more reliable results. The Aetna Informatics department continues to mine those numbers and has found continued promise — and significant dollar savings — in dental/medical integration.
 

Since Aetna began integrating its dental and medical claims data, the results continue to prove the integration case. Here is just a sampling from the database of Aetna Dental/Medical Integration program members:
 

Program members had a 22% reduction in hospital admissions when they sought dental care.
 

Members enrolled in the program use 42% fewer major and basic dental services.
 

Program members experienced a 45% improvement in diabetes control.
 

And 26% fewer cases of low birth weight were recorded.
 

Why integration matters — for members and employers continued
 

Employers save money — directly and through increased productivity.
 

Integrating dental and medical data benefits members in the program, especially those with chronic diseases like diabetes. But it’s also offered advantages to plan sponsors. Quote - “We have been very successful encouraging at-risk members who were not visiting the dentist to begin receiving dental care,” says Mary Lee Conicella, Aetna’s Chief Dental Officer. “By integrating our medical and dental databases, we can coordinate care and provide our members with better overall value and our plan sponsors with a healthier workforce.
 

Quote - “It is in the employer’s best interest to give their employees the tools that help them maintain good health or become healthier if they have chronic conditions. Integrating dental and medical is a big step in that direction.”
 

The statistics point out the value of keeping your workforce healthy. The Aetna Dental/Medical Integration program takes the next logical step. It suggests a direct relationship between health conditions and workplace productivity.
 

Understanding this connection may help employers to assess the impact these risk factors have on their productivity loss. It will also suggest paths for savings that may help them reduce benefits costs.
 

According to the Integrated Benefits Institute, poor health costs the U.S. economy an estimated $576 billion a year. For every dollar of the almost $950 billion spent on health care benefits, another $0.61 of productivity is lost to illness and injury.
 

Workplace health coverage also plays an important role in employee recruitment and retention. A recent survey supports this position.
 

46% of U.S. adults said health coverage was a deciding factor in choosing their current job
 

56% of U.S. adults with health benefits at work said that coverage is a key reason to stay at their current job
 

300k at-risk members identified every year
 

$11.9 million of cost savings delivered to employers in a single year
 

And lowered costs of medical claims by 5%
 

Chapter 4: Aetna Dental/Medical Integration program details
 

The DMI program engages 60% of members in outreach and education.
 

The Aetna Dental/Medical Integration program comes with no extra costs or paperwork for employers — or employees.
 

For busy employers, the integration process is seamless and inclusive. Aetna automatically enrolls at-risk employees with fully insured plans at no cost. There is no additional administrative work. Plan sponsors who are self-insured or work with another health insurance carrier can also use the program.
 

And employees can conveniently access both their medical and dental benefits via one member website and app.
 

The features of the program include: Education by email, phone and mail on how gum disease impacts overall health.
 

A dedicated dental care coordinator who helps members choose a dentist and make appointments.
 

 Enhanced dental benefits.
 

And follow-up support to ensure needed care is provided.
 

Chapter 5: The bottom line
 

Research and studies continue to demonstrate the many ways primary care remains incomplete without the inclusion of oral care as part of the comprehensive health equation.
 

Conversely, with the ongoing evidence and outcomes being revealed by initiatives like the Aetna Dental/ Medical Integration program, or the framework for increased coordination of oral health and mental health that Aetna helped to develop, it is becoming increasingly clear that integrating oral health within primary care is not only important, but also necessary for the improvement of overall care for all Americans.
 

To move oral health and primary care integration forward, clinicians, physicians, insurance carriers, employers and plan sponsors alike must begin to recognize dental coverage as a critical component of health insurance and the health system at large, rather than just an optional benefit.
 

Progress in this effort is being made, but there is still much to do. For the benefit of our members, our partners, and our communities as a whole, it’s vital that we continue to work toward a more comprehensive and equitable system of care.
 

Thank you for listening to Connections Matter- How integrating medical and dental data improves member health and lowers costs for employers.
 

For a full list of sources used in this paper, please go to our website at Aetna.com.

*Ongoing, statistically valid analysis of Aetna Dental/Medical Integration program customers.

Dental wellness tips for employees

 

Good dental care is good for the mouth and body. So share these tips and resources with your employees.
 

Benefits of dental care

 

  • Cuts risk of heart disease
  • Lowers risk of stroke
  • Helps control blood sugar
  • Lowers chance of early delivery during pregnancy
  • Lowers risk of rheumatoid arthritis
     

Simple actions for a healthier mouth

 

  •  Brush twice a day*
  • Floss after brushing
  • Rinse twice a day with antiseptic mouthwash
  • Eat healthy foods
  • Exercise regularly
  • Stop smoking

Dental wellness articles
The mouth-body connection: What your dentist knows about your overall health

Listen to your mouth: 6 signs you need to see the dentist
 

*Choose a toothpaste that contains fluoride and an antibacterial ingredient. Also make sure the toothpaste carries the American Dental Association Seal of Acceptance.

Add whole health to your dental plan

Add whole health to your dental plan

It’s easy with our range of vision, pharmacy and other complementary benefits. They’re available standalone or with any medical plan. Your Aetna rep can tell you more.

More services to make you smile

You’ve got the right dental insurance plan. Now count on us to find the right programs, services and administration to keep your benefits and business running smooth.

Member services

Keep members healthy and engaged with programs and services that keep whole health in mind.

Find services

Health plans

Complete your dental plan with protection for every benefit need — from group medical to Medicare to vision and beyond. 

Find plans

Easy administration

Explore quoting, enrollment and reporting tools to ease administration for plan sponsors and brokers. 

Find administration tools

 

Get to know Aetna Dental

Four dental insurance plan options for flexibility, savings and freedom.

 

Legal notices

In Idaho, dental benefits and dental insurance plans are offered and/or underwritten by Aetna Life Insurance Company. In Texas, the Aetna Dental PPO insurance plan is underwritten by Aetna Life Insurance Company. For all other states, dental benefits and dental insurance plans are offered and/or underwritten by Aetna Health Inc., Aetna Dental Inc., Aetna Dental of California Inc. and/or Aetna Life Insurance Company (Aetna). Each insurer has sole financial responsibility for its own products.

Dental benefits and dental insurance plans contain exclusions and limitations.

See all legal notices

Also of interest: