Aetna Dental Welcomes Rollins College

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Aetna Dental WelcomesRollins College

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Introducing Aetna DMO/PPO Max Indemnity Dental
Plans

• DMO/PPO Max/Indemnity

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DMO Facts

• Approximately 6,800 available dental office
  locations and approximately 17,000 individual
  practitioners
• Primary care dentist selection required
• Change dentist by 15th of month effective 1st
  the following month
• 5 office visit copayment per visit
• Member pays copayments for all services
• Specialty referral required (except
  orthodontists)
• Orthodontia covered for adults and children
• Members receive ID cards
• No deductibles, maximums or claims forms
• Internet access to provider information DocFind
• Styles of Practice
• Out of Network Coverage only
• Pre-Determination for anything over 300.00
• One time emergency authorization available

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Dental PPO Max Facts

• Go to any dentist
• Use Participating PPO Dentist - No Balance
  Billing
• Claims are paid based on fee-scheduled amounts
  for the Central Florida area
• Non-PPO Dentist can charge above fee-schedule
  member can be balanced billed
• Lowest out of pocket costs when using PPO
  Dentists

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Dental PPO Max Plan

• Annual Deductible
• Individual
  50
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  Family 150
• Preventive Services
  100 of fee schedule
• Basic Services
  80 of fee schedule
• Major Services
  50 of fee schedule
• Annual Benefit Maximum 1000
• Orthodontia for adults and children 50
• Orthodontia Lifetime maximum 1000
• No deductible for orthodontia
• Deductible applies to Basic Major services
  only
• -Non network claims paid at the fee-scheduled
  amount

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Dental PPO Max Plan

• Important Information
• Fee Schedule is based on Contracted Rates with
  PPO Dentists NOT Reasonable and Customary Charges
• Example
• John goes to a participating dentist for a
  crown
• Scheduled PPO Amount for Procedure 2750 (crown)
  551
• Assume Deductible Has Been Met
• Plan pays 50 of Maximum PPO Allowance
  275.50
• Member pays 275.50

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Dental PPO Max Plan

• Important Information
• Fee Schedule is based on Contracted Rates with
  PPO Dentists NOT Reasonable and Customary Charges
• Example
• John goes to a non-participating dentist for a
  crown
• Scheduled PPO Amount for Procedure 2750 (crown)
  551
• Non-participating dentist charges
  700
• Assume Deductible Has Been Met
• Plan pays 50 of Maximum PPO Allowance
  275.50
• Member pays 700.00(Dentist Charge)-275.50(Maxi
  mum PPO Allowance) 424.50

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Indemnity Dental Plan

• Go To Any Dentist
• Plan pays at Reasonable Customary (80th
  Percentile)
• Deductible 75.00/150 Family
• Preventive Services 100 of R C
• Basic Service 80 of R C
• Major Services 50 of R C
• Annual Maximum 1000
• Orthodontic Services 50
• Orthodontic Lifetime Maximum 1000

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Dental PlansMonthly Cost To Employees

• DMO
• Employee Only 0.00
• Employee Spouse 10.84
• Employee Child(ren) 18.29
• Family 29.19
• PPO Max
• Employee Only 12.52
• Employee Spouse 36.65
• Employee Child(ren) 35.02
• Family 54.88
• Indemnity Dental
• Employee Only 20.19
• Employee Spouse 52.14
• Employee Child(ren) 49.98
• Family 76.29

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Free Vision Discounts with all plansVision One
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?Questions?