Local 22 Firefighters/Paramedics

/ 22

第五大街415号. 费城., PA 19123.

牙科/安泰

The Plan offers two different dental programs, both administered by Aetna Dental.

Dental Maintenance Organization (DMO) 

The Aetna DMO provides an unlimited annual benefit for 你 and each of 你r eligible dependents; however, 你 必须 use only DMO network providers. You need to select a dentist from the list of Aetna DMO providers and, if 你 require treatment from a dental specialist, 你 must get a referral from 你r primary dentist. If 你 seek treatment from a dental provider who is not in the Aetna DMO network, unless approved in advance by Aetna, no benefit will be paid.

Dental Preferred Provider Organization (PPO) 

The Aetna PPO provides a $5,500 annual benefit for 你 and for each of 你r eligible dependents. +, 你 have the ability to increase 你r annual benefit maximum by $500/year for up to 3 years, for a total annual benefit maximum of $7,000. Just have a preventive service completed in a given year and earn an additional $500 towards 你r maximum for the following year. The PPO provides the flexibility of using providers who are in the PPO network and out of the PPO network. But if 你 use a dentist who is part of the PPO network, 你 will save money. Participating dentists (dentists who are in the Aetna PPO network) have agreed to a negotiated fee with Aetna and cannot bill 你 for amounts above this “allowed amount.” Your out of pocket expenses are any differences between what Aetna allows and the percentage that Aetna pays, as summarized on the chart below, and any amounts that exceed the annual maximum. When 你 use non-participating dentists (dentists who are not in the Aetna network), dental payments are based on Aetna’s allowed amount. If 你r non-participating dentist charges more than the allowed amount 你 can be billed the difference between what Aetna paid and what the dentist charged.

You must enroll in one of the dental plans before 你 and 你r eligible dependents can be covered for dental benefits. You can change from one dental plan to the other only during the Plan’s annual open enrollment period. To find a participating PPO or DMO dentist, call Aetna at 1- or visit their website at www.安泰.com

Summary Of Dental Benefits

  网内 PPO Out of network* OMO
Annual Deductible      
个人 没有一个 没有一个 没有一个
家庭 没有一个 没有一个 没有一个
Preventive Services 100% 100% 100%
基本服务 100% 100% 100%
主要的服务 100% 100% 100%
牙科植入物 100% 100% 不包括
Annual Benefit Maximum.. $5,500 没有一个
Office Visit Copay N/A N/A $0
Orthodontic Services 100% 100% 100%
Orthodontic Deductible 没有一个 没有一个 没有一个
Orthodontic Lifetime Maximum.. $4,000 $4,000 没有一个

* out of Network services reimbursed at % of allowed charge. Out of network providers may bill 你 for the difference between amount charged and amount paid by Aetna.

.. Annual and Lifetime Maximums are total of in-network and out-of-network treatment combined

For more information on 你r Dental program

常见问题——牙科

Do we have more than 1 Dental Plan?

Local 22’s Health Plan offers a Dental PPO and a DMO plan both under AETNA.

Do I have to pick a dentist?

The Aetna DMO provides an unlimited annual benefit for 你 and each of 你r eligible dependents; however, 必须 use only DMO network providers. You need to select a dentist from the list of Aetna DMO providers and, if 你 require treatment from a dental specialist, 你 must get a referral from 你r primary dentist. If 你 seek treatment from a dental provider who is not in the Aetna DMO network, unless approved in advance by Aetna, no benefit will be paid.

The Dental PPO allows 你 to go to any AETNA in-network dentist or out of network providers. 网内 dentist will save 你 money. Participating dentists (dentists who are in the Aetna PPO network) have agreed to a negotiated fee with Aetna and cannot bill 你 for amounts above the “allowed  network negotiated amount.”

Are there any monetary limits on my dental benefits?

There are no monetary limits on covered benefits for the DMO dental plan.

The Dental PPO has a $5,500 per patient annual monetary limit on covered benefits with a lifetime monetary limit on covered Orthodontic benefits of $4,000年每个病人. +, 你 can increase 你r annual benefit maximum by $500/year for up to 3 years, for a total annual benefit maximum of $7,000. Just have a preventive service completed in each year and earn an additional $500 towards 你r maximum for the following year.

Is my dentist required to pre-authorize dental work?

No – It is the members responsibility to ensure the dentist gets the pre-authorization for payment from AETNA prior to getting dental work done. The member could be financially responsible for any dental work performed that is not covered and/or pre-authorized.

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