Network Only Dental Plans (DMO®)
A cost-saving plan that’s so easy to use
Get the benefit of wide coverage, plus the bonus of cost savings. Our Dental Maintenance Organization (DMO)* dental benefits and insurance plan combines the advantages of coordinated care from a primary care dentist (PCD) with a broad range of services to keep members smiling.
Plan features
- DMO is available at a lower cost than a traditional dental PPO insurance plan.
- Members can select a participating PCD from our dental network.
- Eligible preventive, basic and major services are covered.
- PCD referrals and preauthorization are only required when specialty care is needed.
- No referrals are needed for orthodontia, when covered.
- There are no deductibles or dollar maximums, though certain age, frequency and orthodontia limits may apply.
- We offer fixed copay or coinsurance plans to keep costs low.
- DMO is available for fully insured customers. It is available as a stand-alone plan or as part of our Freedom-of-Choice plan design.
- Dual Option: Employers can offer two plan options during open enrollment (separate rates apply): a Preferred Provider Organization (PPO)** dental plan or an indemnity dental plan along with a DMO plan.
- Ability to offer DMO where employees pay 50% or more of the premium (based on underwriting guidelines).
Plan options
Employer cost savings
DMO plan at a glance
| Plans | Plan descriptions | Networks | Plan options | Funding | PCD required | Plan maximum |
|---|---|---|---|---|---|---|
| DMO | A lower-cost dental plan for cost-effective care | DMO | Fixed copay, coinsurance | Fully insured | Yes | No |
| Plans | Plan descriptions | Networks | Plan options | Funding | PCP required | Plan maximum |
|---|---|---|---|---|---|---|
| Freedom-of-Choice | One premium, two plans. Employees can switch each month between a DMO and either a dental PPO*** or indemnity dental insurance plan option that you choose. | DMO and PPO, Aetna Dental PPO II (vendor based)† | DMO: Fixed copay, coinsurance, no deductible |
DMO: Fully insured |
DMO: Yes |
DMO: No |
| Dual Options | Two premiums/rates, two plans. Employees can select either an Aetna DMO or dental PPO or indemnity plan at enrollment (no monthly switch). | No network for Indemnity | PPO or indemnity: Deductible and/or coinsurance |
PPO or indemnity: Fully or self- funded |
PPO or indemnity: no |
PPO or indemnity: no |
*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.
**In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN).
***Plan options may vary by state.
†Included with fully insured plans. Optional with self-funded plans.
Dental benefits and dental insurance plans are offered, underwritten and/or administered 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.
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 information programs provide general dental information and are not a substitute for diagnosis or treatment by a dentist or other health care professional. Dental benefits and dental insurance 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 group size and are subject to change.
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. 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 Oklahoma include: GR-9/GR-9N, GR-23 and/or GR-29/GR-29N.
