CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. CPT only copyright 2015 American Medical Association. It's generally known as the Evidence of Coverage (EOC). Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. Dual Enrollment If you sign up for a dental and/or vision plan during the 2022 Open Season, your coverage will begin on January 1, 2023. Some plans cover comprehensive services. SBBC now offers the option of four dental plans available from three dental carriers. Links to various non-Aetna sites are provided for your convenience only. First time users can also sign up and register for an account. If youre submitting your form online, be sure to attach your receipt to your submission. Visit a dentist in the Aetna Dental PPO* network. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Purchasing the Aetna dental discount cards is easy - online, by mail or by phone. Members must make payments directly to the providers in the Aetna Vital Savings program. Each main plan type has more than one subtype. Dental benefits and dental insurance plans contain exclusions and limitations. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. Pediatric dental essential health benefits include frames for glasses for pediatric patients; the discount for frames may duplicate benefits if you are enrolled in a vision plan that covers your dependent children. When you see a dental care provider for services, you pay up front and get a receipt that includes a description of the services provided. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Program providers are solely responsible for the products and services they provide. Please consult with the respective plan detail page for additional plan terms. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. 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. Dental implants, false teeth, prosthetic restoration of dental implants, plates, dentures, braces, mouth guards, and other devices to protect, replace or reposition teeth and removal of implants You also have the flexibility to visit a licensed dentist who does not participate in our network. Unlisted, unspecified and nonspecific codes should be avoided. And one of the main perks of joiningaMedicare Advantage (MA)planis that many plans offer dental coverage to helpyoukeep upwithyour oral health. Links to various non-Aetna sites are provided for your convenience only. * In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 2022 Aetna Dental 2 Enroll at www.BENEFEDS.com . ** Out-of-network benefits are paid based on recognized charge levels, as determined by Aetna and specified in your plan documents. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 2022 A Nationwide Dental PPO Plan IMPORTANT Rates: Back Cover Changes for 2022: Page 4 . Are there any waiting periods? License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. You can choose from thousands of dental providers nationwide, including those who offer virtual dental visits. Original Medicare, on the other hand, does not coverroutinedental care, such as cleanings, X-rays,andfillings. Understand the link between infections in the mouth, and their impact on other parts of the body. While most dental plans require a waiting period for major services like crowns or root canals, if you switch from your existing comparable plan to an Aetna plan, we will waive the waiting period. But your plan features and costs will vary depending on the plan you choose. To view the form just select Continue. For language services, please call the number on your member ID card and request an operator. This Agreement will terminate upon notice if you violate its terms. PLAN EXCLUSIONS AND LIMITATIONS* Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. CPT only Copyright 2022 American Medical Association. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. CPT only Copyright 2022 American Medical Association. How is coverage handled overseas? Coinsurance: the percentage of dental care expenses you pay after your deductible. If your MA plan doesnt include dental coverage, or you want to increase your coverage, you may have the option to purchase dental benefits for an additional monthly premium. Aetna Medicare is a HMO, PPO plan with a Medicare contract. ZIP CODE View 2023 plans Learn about these benefits Dental, eyewear and hearing coverage is available. Disclaimer of Warranties and Liabilities. Check your Evidence of Coverage (EOC) for more details. That would not be made if you did not have coverage. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Cigna DPPO networks offer convenient access to quality dentists all across the country and savings on covered dental services. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. All services deemed "never effective" are excluded from coverage. Links to various non-Aetna sites are provided for your convenience only. If you do not intend to leave our site, close this message. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. the difference in cost between the approved less costly service and the more costly covered service. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Your InstaMed log in may be different from your Caremark.com secure member site log in. The EOC is the legal contract between you and the Medicare plan. Caremark.com is the secure website where Aetna Medicare SilverScript members can manage prescriptions, sign up for mail delivery, view order status, find drug pricing, and identify savings options. Aetna Inc. and its affiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. FEDVIP Program Highlights A Choice of Plans and . By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Preventive services Waiting period*: None, Basic services are covered at 80% with in-network providers (after deductible), Major services are covered at 50% with in-network providers (after deductible), Waiting periods for basic and major care waived with prior dental insurance, No waiting periods for preventive services, See any dentist, but youll save more if you stay in network, 100% coverage for preventive services when you see an in-network dentist, Basic services covered at 80% with in-network providers (after deductible), Major services covered at 50% with in-network providers (after deductible), Waiting periods* for Basic and Major services waived with prior dental insurance, $50 individual / $150 family per calendar year, Waiting period is waived if all family members enrolling had dental coverage within the past 90 days. It is only a partial, general description of plan or program benefits and does not constitute a contract. Pricing starts at $20 in most regions, and also includes: No waiting periods Inclusive plans. This information is neither an offer of coverage nor medical advice. Get the coverage you need to keep your mouth, teeth and gums healthy. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Members must enroll in this option when they enroll in their plan, or within 30 days of their plans start date. 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). You may pay more when you get care from dentists who arent in the network.**. Thats it. 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. Message and data rates may apply.***. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Aetna Inc. and its affiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Aetna makes no payment to the third parties you are responsible for the full cost. This information is neither an offer of coverage nor medical advice. CPT is a registered trademark of the American Medical Association. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. Aetna is continuing to expand the Aetna Dental PPO network across the country to . ChooseHealthy is a federally registered trademark of ASH and used with permission herein. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. The employee pays the remainder through payroll deduction Premiums are deducted on a pre-tax basis Contact Information at Aetna Customer Service 1-877-238-6200 or www.aetna.com About the Plan Aetna Dental Summary - Effective January 1, 2023 Dental services and supplies made with high noble metals (gold or titanium) except as covered in the Eligible Dental Services section of your insurance policy Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. DISCOUNT OFFERS ARE NOT INSURANCE. Links to various non-Aetna sites are provided for your convenience only. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. As of April 4, 2022, Medicare covers up to eight over-the-counter COVID-19 tests each month, at no extra cost to you if you have . With adirect member reimbursementallowance, youre givena set amount of money to spend each year on dental care.. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". That are provided by a family member. 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. Sign up at BeneFeds.com or call 1-877-888-3337. This may be a copay, which is a set dollar amount. Enrollment in our plans depends on contract renewal. For which you have no legal obligation to pay. Reprinted with permission. Aetna Medicare SM Plan (PPO) Learn more about Aetna Feeling Good: Your Verizon Aetna magazine Check out Feeling good , the magazine created specifically for Verizon Aetna members. 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. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Each main plan type has more than one subtype. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. We've broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. Aetna handles premium payments through InstaMed, a trusted payment service. Network dentists offer special rates for covered services. 2022 - 2023 Aetna PPO Dental Plan Design and Benefits Summary Visit any licensed dentist - in or out of network In network: Visit a dentist in the Aetna Dental PPO* network. By submitting your information you are agreeing to receive communications from Aetna Dental Offers. Certain preventive care services are covered at little-to-no-extra cost 2 when . Dental insurance plans contain exclusions and limitations. Dental care, eyewear and hearing aids Many of our Medicare Advantage plans include dental, eyewear and hearing benefits. Dental care is a vital part of maintaining yourhealth and well-being, especially as you age. Instead, check your benefits summary to find your share of the costs. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. This means you pay nothing out of pocket if you stay in network. This benefit provides coverage of preventive and comprehensive dental services up to a benefit maximum and allows the member to choose any licensed dentist, in or out of network. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. You are now being directed to the CVS Health site. The information you will be accessing is provided by another organization or vendor. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Aetna Medicare Advantage plans provide benefits that original Medicare does not. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). When you have an Aetna Dental plan, you know youre taking the right steps toward being healthy. Members should discuss any matters related to their coverage or condition with their treating provider. Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. Actual costs and savings may vary by provider, service and geographic location. Treating providers are solely responsible for dental advice and treatment of members. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. You are leaving our Medicare website and going to our non-Medicare website. Preventive services such as cleanings, oral exams and X-rays are covered at 100 percent on most plans. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Were bringing you to our trusted partner to help process your payments. Temporomandibular joint dysfunction/disorder. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. Youcansee anylicenseddental provider in the U.S. You can use the allowance toward almost all dental services except for teeth whitening and a few administrative costs (e.g., missed appointments). The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Important Disclaimers for Medicare Members For questions on your dental benefits, call us 1-866-409-0937 (TTY: 711). Instruction for diet, plaque control and oral hygiene Links to various non-Aetna sites are provided for your convenience only. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. Do you cover implants? Includes PPO, HMO, HMO-POS medical plans with or without drugs. That are not medically necessary. They are not benefits under your insurance plan. All Rights Reserved. For additional language assistance: Espaol | | Ting Vit | | Tagalog | P | | Kreyl | Franais | Polski | Portugus | Italiano | Deutsch | | | Other Languages. **Out-of-network benefits vary by state and are subject to certain charge limits. Aetna's 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). New and revised codes are added to the CPBs as they are updated. Some subtypes have five tiers of coverage. It's generally available starting in September and describes costs and benefits of your plan that will take effect on January 1 of the following year. As you plan for your dental care, keep in mind that you may have limits on the amount of preventive care visits you can make each year, as well as caps on coverage for comprehensive services. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. The three carriers providing service to the District's employees are CompBenefits/Humana (Basic and Enhanced PPO/Indemnity and DHMO Managed Care), Aetna (Basic and Enhanced PPO/Indemnity), and Aetna (Basic and Enhanced DHMO Managed Care). U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. You may also have to file your own claims. Enrollment in this voluntary dental plan is open to all registered students and their eligible dependents. The ABA Medical Necessity Guidedoes not constitute medical advice. The program does not make any payments to providers. For language services, please call the number on your member ID card and request an operator. Password * Forgot Password? It is not available in Montana, Vermont or Tennessee. Or log in to your member account to submit the form online. 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. All services deemed "never effective" are excluded from coverage. For someAetna MA plansthatdontincludedental coverage, you mayhave the choiceof payingextra each month for dental benefits. Aetna Dental has over 50 years of experience offering dental benefits. This is the total amount per person your plan will pay toward the in-network cost of dental care each year. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl. Some of the covered dental services may include (be sure to check with your plan for details): If you have network or OSB coverage, you may be limited to a specific number of services per year. You are now being directed to CVS Caremark site. 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. Aetna dental plans are not considered to be qualified health plans under the Affordable Care Act. Go to the American Medical Association Web site. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-877-698-4825, is the Discount Medical Plan Organization. Aetna Dental Coverage | New York State Nurses Association Home Aetna Dental Coverage For more information on NYSNA dental benefits, offered through Aetna, please refer to the following documents ( .pdf; Adobe Acrobat Reader required): Aetna Navigator Website Introduction Aetna PPO Overview Dental Benefits Summary (NYSNA Full-time RNs) Participating dentists have agreed to provide services at a negotiated rate for covered services. Links to various non-Aetna sites are provided for your convenience only. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Premium deductions will start with the first full pay period CPT only copyright 2015 American Medical Association. You have the freedom to care for your smile your way with this PPO plan. You can choose from one of the more than 420,000* dental providers nationwide. How we make it simple for you About Medicare Advantage We're here to help you learn more about what you can get out of Medicare Advantage. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. App Store is a service mark of Apple Inc. Android and Google Play are trademarks of Google LLC. Network dentists also file claims for you. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Crown, inlays and onlays, and veneers unless for one of the following: Some plans will cover around 50% of adult orthodontic treatment (including Invisalign), while others will only cover children up to 19 years old. A Nationwide Dental PPO Plan Who may enroll in this plan: All Federal employees, annuitants, and . In excess of the benefit, dollar, day, visit, or supply limits stated in your schedule of benefits. Aetna MA plans offer three types of dental coverage: For HMO plans, you must see a dental care provider within the network of approved providers. 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. PGCPS pays 75% of monthly premium for dental, the PGCPS share increases to 80% after 8 years of service. This benefit maximum can range from about $150 to $6,000. Send the form with the receipt to the claims address found on your member ID card. Others have four tiers, three tiers or two tiers. The Aetna Vital Savings discount program is not insurance. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. your coverage will begin on January 1, 2022. So, your share of the cost is usually lower.
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