Some subtypes have five tiers of coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. . Aetna may receive a percentage of the fee you pay to the discount vendor. If more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service. If your plan doesnt include dental coverage, or you want to increase your coverage, you may have the option to purchase dental benefits with an additional monthly premium (coverage varies by plan). For language services, please call the number on your member ID card and request an operator. Get discounts on oral health care products like Z Sonic toothbrushes, replacement brush heads and various oral health care kits. - The tooth is an abutment to a covered partial denture or fixed bridge. Dental network Direct Member Reimbursement (DMR) Not sure If you're covered through a former employer, union, trust or other retirement system, then you have a dental network plan and are covered by the Aetna Dental PPO network. Youll pay for your dental care up front when you see a dentist, and then submit your receipts to Aetna for reimbursement. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Preferred Provider Organization (PPO) plans. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Includes PPO, HMO, HMO-POS medical plans with or without drugs. Learn more and see if your dentist is in the network with these plans on aetna.com. 5 Visit AetnaMedicare.com to learn more about the 2022 Aetna Medicare plans. Aetna Dental provides national network coverage for Prince George's County Government through two networks: You receive greater benefit coverage when you use a provider who participates in the Aetna Dental participating network. Aetna Medicare Advantage plans provide benefits that original Medicare does not. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. Aetna Medicare Dental Provider Results - sslws.net Pricing starts at $20 in most regions, and also includes: No waiting periods Inclusive plans. Claims must be submitted within 365 days of the date you received the service. Unlisted, unspecified and nonspecific codes should be avoided. Aetna Medicare dental plans: Coverage, eligibility, and costs The member's benefit plan determines coverage. Get savings on weight-loss programs and meal plans, and enjoy one-on-one help, personalized menus, online tools and chat rooms. Tooth Missing But Not Replaced Rule In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Coverage Period: 01/01/2022 - 12/31/2022 Coverage for: Self Only, Self Plus One or Self and Family | Plan Type: PPO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. Massachusetts license number: 10041444. The AMA is a third party beneficiary to this Agreement. Aetna Dental plans come with special perks and discounts, including exclusive offers from CVS Health. Best Dental Insurance Plans for Seniors in 2023 - The Senior List By texting 90156, you consent to receive a one-time marketing automated text message from Aetna with a link to download the Aetna Health app. Dental PPO insurance plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). 5. Legal notices Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). Treating providers are solely responsible for medical advice and treatment of members. It is only a partial, general description of plan or program benefits and does not constitute a contract. That are experimental or investigational. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. The school has chosen a plan that makes it easy to keep your smile. First time users can also sign up and register for an account. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Temporomandibular joint dysfunction/disorder. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Spirit Dental & Vision is a nationwide carrier that offers a range of PPO dental insurance plan. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. You may also have to file your own claims. View your plan details. Treating providers are solely responsible for medical advice and treatment of members. General anesthesia and intravenous sedation, unless specifically covered and only when done in connection with another eligible dental service In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. CPT is a registered trademark of the American Medical Association. If you do not intend to leave the Medicare site, close this message. DISCOUNT OFFERS ARE NOT INSURANCE. You have the freedom to care for your smile your way with this PPO plan. Your dental plan may have yearly and lifetime limits on coverage. As you age, maintaining your oral health is an important part of your whole-body wellness. Go to the American Medical Association Web site. If youre submitting your form online, be sure to attach your receipt to your submission. The SBC shows you how you and the plan would share the cost for covered health care services. Provided for your personal comfort or convenience, or the convenience of any other person, including a dental provider. Sign up at BeneFeds.com or call 1-877-888-3337. Please consult with the respective plan detail page for additional plan terms. Selection of a program provider is also the responsibility of the participant and is not based on any representations by Aetna. The change will start the first day of the next month. What's an Evidence of Coverage (EOC)? | Aetna Medicare All services deemed "never effective" are excluded from coverage. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Your dental plan pays the rest. The member's benefit plan determines coverage. Caring for your teeth should never feel out of reach with Aetna Dental Direct. Under the Dental Preferred Provider Organization (PPO) plan, you may choose at the time of service either a PPO participating dentist or any nonparticipating dentist. For which you have no legal obligation to pay. Instruction for diet, plaque control and oral hygiene For comprehensive services, such as fillings, extractions and crowns, the coverage varies according to plan, and you may have to pay a portion of the cost of services. The information you will be accessing is provided by another organization or vendor. Program providers are solely responsible for the products and services they provide. Get a discount on blood pressure montiors, pedometers, activity trackers, pain relief devices and other Omron products. Replacement of teeth beyond the normal complement of 32 Aetna Dental Direct insurance plan is offered by Aetna Life Insurance Company (Aetna). PGCPS pays 75% of monthly premium for dental, the PGCPS share increases to 80% after 8 years of service. Links to various non-Aetna sites are provided for your convenience only. Weve broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. All Rights Reserved. 2022 Aetna Medicare Choice Plan (PPO) in Santa Fe, New Mexico
