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Dental DMO Video

Dental DMO video transcript

[music]

Hi, I’m David, and this is Aetna’s Dental Maintenance Organization, or DMO, the dental benefits plan that gives you a lot of coverage and great care with an affordable price tag.  The DMO has no deductible.  You’re covered from day one.  And unlike most conventional plans, the DMO has no annual dollar maximum.  So, no matter how much work you need, you’re still covered.  Even better, preventive care, like exams, x-rays, and cleanings, is almost always covered 100 percent.  Plus, the DMO is great for families with lower copays and co-insurance, and great orthodontia coverage.  The savings really add up compared to a conventional plan.  Just choose your primary care dentist from Aetna’s network, one of the largest DMO networks in the business with over 81,000 available dental practice locations. 

That’s Aetna’s DMO.

*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.
**These facts are as of December 2013 based on Aetna provider data.
Exclusions and Limitations
Some services not covered are:

1. Services or supplies that are covered in whole or in part:
a) under any other part of this Dental Care Plan; or
b) under any other plan of group benefits provided by or through your employer.
2. Services and supplies to diagnose or treat a disease or injury that is not:
a) a non-occupational disease; or
b) a non-occupational injury.
3. Services not listed in the Dental Care Schedule that applies, unless otherwise specified in the Booklet-Certificate.
4. Those for replacement of a lost, missing or stolen appliance, and those for replacement of appliances that have been damaged due to abuse, misuse or neglect.
5. Those for plastic, reconstructive or cosmetic surgery, or other dental services or supplies, that are primarily intended to improve, alter or enhance appearance. This applies whether or not the services and supplies are for psychological or emotional reasons. Facings on molar crowns and pontics will always be considered cosmetic.
6. Those for or in connection with services, procedures, drugs or other supplies that are determined by Aetna to be experimental or still under clinical investigation by health professionals.
7. Those for dentures, crowns, inlays, onlays, bridgework, or other appliances or services used for the purpose of splinting, to alter vertical dimension, to restore occlusion, or to correct attrition, abrasion or erosion.
8. Those for any of the following services:
a) An appliance or modification of one if an impression for it was made before the person became a covered person;
b) A crown, bridge, or cast or processed restoration if a tooth was prepared for it before the person became a covered person;
c) Root canal therapy if the pulp chamber for it was opened before the person became a covered person.
9. Services that Aetna defines as not necessary for the diagnosis, care or treatment of the condition involved. This applies even if they are prescribed, recommended or approved by the attending physician or dentist.
10. Those for services intended for treatment of any jaw joint disorder, unless otherwise specified in the Booklet-Certificate.
11. Those for space maintainers, except when needed to preserve space resulting from the premature loss of deciduous teeth.
12. Those for orthodontic treatment, unless otherwise specified in the Booklet-Certificate.
13. Those for general anesthesia and intravenous sedation, unless specifically covered. For plans that cover these services, they will not be eligible for benefits unless done in conjunction with another necessary covered service.
14. Those for treatment by other than a dentist, except that scaling or cleaning of teeth and topical application of fluoride may be done by a licensed dental hygienist. In this case, the treatment must be given under the supervision and guidance of a dentist.
15. Those in connection with a service given to a dependent age 5 or older if that dependent becomes a covered dependent other than:
a) during the first 31 days the dependent is eligible for this coverage, or
b) as prescribed for any period of open enrollment agreed to by the employer and Aetna. This does not apply to charges incurred:
i. after the end of the 12-month period starting on the date the dependent became a covered dependent; or
ii. as a result of accidental injuries sustained while the dependent was a covered dependent; or
iii. for a primary care service in the Dental Care Schedule that applies as shown under the headings Visits and Exams, and X-rays and Pathology.
16. Services given by a nonparticipating dental provider to the extent that the charges exceed the amount payable for the services shown in the Dental Care Schedule that applies.
17. Those for a crown, cast or processed restoration unless:
a) It is treatment for decay or traumatic injury and teeth cannot be restored with a filling material; or
b) The tooth is an abutment to a covered partial denture or fixed bridge.
18. Those for pontics, crowns, cast or processed restorations made with high-noble metals, unless otherwise specified in the Booklet-Certificate.
19. Those for surgical removal of impacted wisdom teeth only for orthodontic reasons, unless otherwise specified in the Booklet-Certificate.
20. Services needed solely in connection with non-covered services.
21. Services done where there is no evidence of pathology, dysfunction or disease other than covered preventive services.

Dental benefits and dental insurance plans are underwritten by Aetna Dental Inc., Aetna Dental of California Inc., Aetna Health Inc. and/or Aetna Life Insurance Company, and in Texas by Aetna Dental Inc., (Aetna).    Each insurer has sole financial responsibility for its own products.

If you require language assistance from an Aetna representative, please call the Member Services number located on your ID card, and you will be connected with the language line if needed; or you may dial direct at 1-888-982-3862. (140 languages are available. You must ask for an interpreter.) TDD 1-800-628-3323 (hearing impaired only).

Si requiere la asistencia de un representante de Aetna que hable su idioma, por favor llame al número de Servicios al Miembro que aparece en su tarjeta de identifi cación y se le comunicará con la línea de idiomas si es necesario; de lo contrario, puede llamar directamente al 1-888-982-3862. (140 idiomas disponibles. Debe pedir un intérprete.)  TDD-1-800-628-3323 (sólo para las personas con impedimentos auditivos).

This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Rates and benefits vary by location. Dental providers are independent contractors and are not agents of Aetna.  Provider participation may change without notice. Aetna does not provide care or guarantee access to dental services. Dental benefits plans contain exclusions and limitations. Not all dental services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and/or group size and are subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com.  

Policy forms issued in OK include:  GR-9/GR-9N. GR-23 and/or GR-29/GR-29N.

© 2014 Aetna Inc.

09.27.301.1 A (01/14)

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