2022 Aetna Medicare Choice Plan (PPO) in Santa Fe, New Mexico Under certain plans, 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 provided that certain terms are met. Disclaimer of Warranties and Liabilities. 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. With our HMO-POS plans, you can enjoy all the benefits of receiving medical care through a network provider. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. You can start using your plan right away! CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Replacement of teeth beyond the normal complement of 32 Under certain plans, 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 provided that certain terms are met. Treating providers are solely responsible for medical advice and treatment of members. Medicare coverage for the whole you body, mind and spirit, Discover coverage that takes a total approach to health, See how we help you get the right resources and care, Take full advantage of everything your plan offers you. Plan 41 Effective Date: 01-01-2022 Hampshire, Middlesex, Norfolk, Plymouth, Suffolk and Worcester. Pay your share of the cost. Visit any licensed dentist outside the network. Annual Deductible $50 Per Person $150 Per Family, per calendar year, Annual Maximum Benefit $1,250 per covered person. Members must make payments directly to the providers in the Aetna Vital Savings program. Some plans cover comprehensive services. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Your out of pocket expenses will be higher if you do not see an in-network provider and, in some plans, benefits may not be available at all for out-of-network providers. For additional language assistance: Espaol | | Ting Vit | | Tagalog | P | | Kreyl | Franais | Polski | Portugus | Italiano | Deutsch | | | Other Languages. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Note not all Aetna dental plans and offers available in all markets. General anesthesia and intravenous sedation, unless specifically covered and only when done in connection with another eligible dental service Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Please consult with the respective plan detail page for additional plan terms. If you enroll in an Aetna Medicare Advantage plan that includes dental coverage, some of the services that may be covered include: Teeth cleaning, scaling and polishing Office visits for oral examinations Non-surgical extractions Fillings Minor denture adjustments X-rays Oral hygiene instruction Dietary advice and counseling Minor bite adjustments Dentures, crowns, inlays, onlays, bridges, or other appliances or services used for the purpose of splinting, to alter vertical dimension, to restore occlusion, or correcting attrition, abrasion, or erosion Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Check your Evidence of Coverage (EOC) for more details. Studies show that a healthy mouth helps you avoid health problems in the body, too. Aetna offers two Dental PPO insurance plans to individuals and families, the Aetna Dental Direct Preferred and the Aetna Dental Direct Core. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. The Aetna Vital Savings discount program is not insurance. ZIP CODE View 2023 plans Learn about these benefits Dental, eyewear and hearing coverage is available. We make dental care convenient. 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. Student health insurance plans are underwritten by Aetna Life Insurance Company (Aetna). Program providers are solely responsible for the products and services they provide. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. But do you know that your oral health is linked to many medical conditions? In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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. Enjoy discounts on hearing aids, exams and hearing aid batteries mailed to your home. 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. Aetna Inc. and itsaffiliated 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. Enrollment in our plans depends on contract renewal. PDF Summary of Benefits and Coverage: What this Plan Covers - Aetna Feds Youre given an annual allowance to spend on dental care. 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. Learn more about our network and DMR plans Search other providers Need a provider directory? SBBC now offers the option of four dental plans available from three dental carriers. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-877-698-4825, is the Discount Medical Plan Organization. Want to see options for a different location? Certain preventive care services are covered at little-to-no-extra cost 2 when . Click here to review plans with a $0 deductible. Applicable FARS/DFARS apply. offering the same type of coverage; i.e., you (or covered family members) cannot be covered by two FEDVIP dental plans or two FEDVIP vision plans. Weve broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. CPT only Copyright 2022 American Medical Association. For prescribed drugs, pre-treatments or analgesia. These dental benefits follow the same structure as network plans and may require you to choose a dental provider within your network. Treating providers are solely responsible for dental advice and treatment of members. 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. Tooth Missing But Not Replaced Rule Coverage for the first installation of removable dentures; fixed bridgework and other prosthetic services is subject to the requirements that such removable dentures, fixed bridgework and other prosthetic services are: needed to replace one or more natural teeth that were removed while this policy was in force for the covered person; and are not abutments to a partial denture; removable bridge; or fixed bridge installed during the prior 8 years. PDF A Nationwide Dental PPO Plan - BENEFEDS Overall, it is very affordable compared to competitors and comes with many different amounts of coverage. Find your dentist now in Aetna's large nationwide network. 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. Since there is no paperwork or reimbursement, you must pay for the service at the time its provided. Aetna Health members, log-in securely to your account to access all of your health and benefits information, or get your user name and/or password if you've forgotten it. Everyone can get their own in-network primary care dentist. Coinsurance: the percentage of dental care expenses you pay after your deductible. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Aetna dental insurance for seniors offers three different plans to choose from. If you do not intend to leave our site, close this message. Information is believed to be accurate as of the production date; however, it is subject to change. 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. It gives members access to discounted fees according to schedules negotiated with providers by Aetna Life Insurance Company for Aetna Vital Savings. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. For language services, please call the number on your member ID card and request an operator. Dental care, eyewear and hearing aids Many of our Medicare Advantage plans include dental, eyewear and hearing benefits. Dental Insurance Plans for Individuals & Families | Aetna 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 Aetna Dental Direct plan covers preventative care 100% with no out of pocket cost. This site has its own log in. See your Evidence of Coverage for details. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. For more information, please call HSA Consulting Customer Service at (888) 978-8355. Dental Preferred Provider Organization (DPPO) Plans | Cigna Why choose ${company} Medicare Solutions? CPT only Copyright 2022 American Medical Association. Understand the link between infections in the mouth, and their impact on other parts of the body. All services deemed "never effective" are excluded from coverage. Links to various non-Aetna sites are provided for your convenience only. Cons. Some preferred provider organization (PPO) and health maintenance organization point-of-service (HMO-POS) plans, however, do allow you to see any licensed dental provider, but you may save money by seeing a provider in our network.
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