Aetna handles premium payments throughInstaMed, a trusted payment service. See your PCD for regular exams and to get referrals if you need specialty care. 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. Go to the American Medical Association Web site. Premium deductions will start with the first full pay period 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. 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. Pricing starts at $20 in most regions, and also includes: No waiting periods Inclusive plans. Send the form with the receipt to the claims address found on your member ID card. 5 Visit AetnaMedicare.com to learn more about the 2022 Aetna Medicare plans. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". 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. The change will start the first day of the next month. Program providers are solely responsible for the products and services they provide. 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. 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 . Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. You are now being directed to the CVS Health site. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Covered family members can choose their own PCDs. Aetna offers two Dental PPO insurance plans to individuals and families, the Aetna Dental Direct Preferred and the Aetna Dental Direct Core. The availability of a particular provider cannot be guaranteed and provider network composition is subject to change. Aetna Inc. and itsitsaffiliated 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. Spirit Dental & Vision is a nationwide carrier that offers a range of PPO dental insurance plan. Aetna Dental Savings Plans are NOT dental insurance and the dental savings will vary by provider, plan and zip code. 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). 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 Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. Get lower rates when you go to a dentist thats in your PPO network. Special perks and discounts, including exclusive offers from CVS Health, Search for providers in-network by using our. For PPO plans and most HMO-POS plans, you have the option to go to any licensed provider, but could save money by using a provider in the network. Aetna Dental has over 50 years of experience offering dental benefits. Message and data rates may apply.***. The information you will be accessing is provided by another organization or vendor. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. The AMA is a third party beneficiary to this Agreement. To view the form just select Continue. Aetna dental insurance comes with stand-alone dental coverage or dental, vision, and hearing coverage. Pros. Disclaimer of Warranties and Liabilities. Do you cover adult orthodontia? Deductible applies to basic and major services only. Purchasing the Aetna dental discount cards is easy - online, by mail or by phone. Provided for your personal comfort or convenience, or the convenience of any other person, including a dental provider. California license number: OB84599. Treating providers are solely responsible for dental advice and treatment of members. Use order code 123AET200. CPT only Copyright 2022 American Medical Association. 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. Get savings on weight-loss programs and meal plans, and enjoy one-on-one help, personalized menus, online tools and chat rooms. 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. Print and fill out the reimbursement form. 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. 4. . The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Cancelled or missed appointment charges or charges to complete claim forms. CPT is a registered trademark of the American Medical Association. 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. For language services, please call the number on your member ID card and request an operator. Whats covered under Medicare Advantage dental plans. Choose from leading manufacturers and get free follow-up service for one year. 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. The SBC shows you how you and the plan would share the cost for covered health care services. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Do you cover Invisalign braces? 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. However, if you do this, you wont benefit from negotiated rates. Get the coverage you need to keep your mouth, teeth and gums healthy. You can find a network provider by logging in as a member and going to our provider directory. You are now being directed to the CVS Health site. ZIP CODE View 2023 plans Learn about these benefits Dental, eyewear and hearing coverage is available. The ABA Medical Necessity Guidedoes not constitute medical advice. Each main plan type has more than one subtype. Direct member reimbursement allowance: How to get reimbursed for dental care. For work that began before you were covered under the plan, The following dental services and supplies. Taking care of your teeth is as an important part of taking care of your health. All care is the responsibility of the treating provider, in consultation with the participant. Members should discuss any matters related to their coverage or condition with their treating provider. Actual costs and savings may vary by provider, service and geographic location. One thing to keep in mind as you plan for dental care with this plan is that the cost of certain dental procedures and services can vary according to each provider. 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. Enjoy discounts on hearing aids, exams and hearing aid batteries mailed to your home. ${tty} to chat about any Medicare questions you have. Routine dental care can help you have stronger teeth, healthier gums and a brighter smile. 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. In case of a conflict between your plan documents and this information, the plan documents will govern. Dental care is a vital part of maintaining yourhealth and well-being, especially as you age. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). Members should discuss any matters related to their coverage or condition with their treating provider. Dental plans are all different. Aetna Dental Direct | Secure Member Portal Login Secure Member Portal * required Username * Forgot Username? Weve broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. Since Dental Clinical Policy Bulletins (DCPBs) 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. 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. your coverage will begin on January 1, 2022. If you have more questions, just call us at 1-866-241-0356 (TTY: 711), Monday through Friday, 8 AM to 9 PM ET. See your Evidence of Coverage for details. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Aetna Dental has over 60 years of experience offering dental benefits. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. 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. 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. It does not meet the Minimum Creditable Coverage requirements in Massachusetts. 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. Get coverage to any doctor (in or out-of-network) at the same member cost share. Just check with your employer to see which plans are available to you. Aetna does not endorse any vendors, products or services associated with this program. Rendered before the effective date or after the termination of coverage, unless coverage is continued under the Special coverage options after your plan coverage ends section of your policy. Visit a dentist in the Aetna Dental PPO* network. 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. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". You can change your PCD once a month on your member website. Surgical removal of impacted wisdom teeth when only for orthodontic reasons Get discounts on oral health care products like Z Sonic toothbrushes, replacement brush heads and various oral health care kits. 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. In Pennsylvania, the waiting period is called an elimination period and most Basic services have one month waiting period. Applicable FARS/DFARS apply. Deductible and annual maximum amounts cross-apply between in network and out of network. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). Aetna dental plans are not considered to be qualified health plans under the Affordable Care Act. With adirect member reimbursementallowance, youre givena set amount of money to spend each year on dental care.. 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. While we encourage you to submit all claims electronically, if you need to submit a paper claim, Review our paper claim Tips. 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. 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. Links to various non-Aetna sites are provided for your convenience only. Information is believed to be accurate as of the production date; however, it is subject to change. Preferred Provider Organization (PPO) plans. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Digital tools to easily manage your care and access your ID card whenever needed. Aetna will continue to offer most Medicare Advantage members access to routine vision, dental and hearing coverage. Visit your PCD: If you see someone other than your selected PCD, you could end up paying more. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. With our HMO-POS plans, you can enjoy all the benefits of receiving medical care through a network provider. You may also have to file your own claims. So, your share of the cost is usually lower. 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. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. 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 you'll save more if you stay in network Annual Deductible $50 Per Person $150 Per Family, per calendar year You are leaving our Aetna Medicare website and going to an Aetna Medicaid website. We encourage you to check with your participating provider prior to beginning treatment. New and revised codes are added to the CPBs as they are updated. 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 addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Language services can be provided by calling the number on your member ID card. Once youre a member, you have two ways to engage with your plan online. For more info about your no-cost OneTouch BGM for Aetna Medicare plan members, you can visit us online or call 1-877-764-5390 ${tty} without a prescription. Network dentists offer special rates for covered services. AetnaDentalOffers.com is brought to you by DentalPlans.com. Were bringing you to our trusted partner to help process your payments. Note not all Aetna dental plans and offers available in all markets. Get a discount on blood pressure montiors, pedometers, activity trackers, pain relief devices and other Omron products. 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. All Rights Reserved. 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. Crown, inlays and onlays, and veneers unless for one of the following: 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. Most of our HMO-POS plans require you to use a network provider for medical care but provide you with flexibility to go to licensed dentists in or out of network for routine dental care. You can choose from one of the more than 420,000 dentist locations in the Aetna Dental PPO network. Plan 41 Effective Date: 01-01-2022 Hampshire, Middlesex, Norfolk, Plymouth, Suffolk and Worcester. In case of a conflict between your plan documents and this information, the plan documents will govern. * 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. Please log in to your secure account to get what you need. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The Aetna Dental Direct plan covers preventative care 100% with no out of pocket cost. 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. Click here to review plans with a $0 deductible. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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. With Aetna MA plans that include a direct member reimbursement (DMR) allowance, members are given a set amount of money to spend each year on dental care. When you have an Aetna Dental plan, you know youre taking the right steps toward being healthy. With a PPO plan, you can visit any dentist you want (whether they are in or out of the network) and usually receive some coverage level. You are now being directed to CVS Caremark site. Learn more and see if your dentist is in the network with these plans on aetna.com. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. For work-related conditions. Applicable FARS/DFARS apply. - The tooth is an abutment to a covered partial denture or fixed bridge. The AMA is a third party beneficiary to this Agreement. Aetna Inc. and itsitsaffiliated 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 benefits plan determines coverage. Pay your share of the cost. 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. Your InstaMed log in may be different from your Caremark.com secure member site log in. ChooseHealthy is a federally registered trademark of ASH and used with permission herein. 2022 . Overall, it is very affordable compared to competitors and comes with many different amounts of coverage. You also have the flexibility to visit a licensed dentist who does not participate in our network. Dental PPO insurance plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). But your plan features and costs will vary depending on the plan you choose. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. 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. 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. It may be different from your Aetna secure member site log in. We've broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. Student health insurance plans are underwritten by Aetna Life Insurance Company (Aetna). Caring for your teeth should never feel out of reach with Aetna Dental Direct. DISCOUNT OFFERS ARE NOT INSURANCE. This means you pay nothing out of pocket if you stay in network. 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. Please be sure to add a 1 before your mobile number, ex: 19876543210. 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. The amount of the discounts will vary depending on the provider and type of service or supply received. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Dual Eligible Special Needs Plans (D-SNP). *Acupuncture is an essential health benefit, and the discount for this service may duplicate benefits if you are enrolled in a full-service 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. No fee schedules, basic unit, relative values or related listings are included in CPT. Not available in many states. You will receive the discount off the providers usual and customary fees when you pay. Selection of a program provider is also the responsibility of the participant and is not based on any representations by Aetna. If you do not intend to leave Aetna Medicare, close this message. In MD and NJ, student medical insurance is underwritten by Aetna Health and Life Insurance Company (AHLIC).Self-insured plans are funded by the applicable school, with claims administration services provided by Aetna Life Insurance Company. When billing, you must use the most appropriate code as of the effective date of the submission. For language services, please call the number on your member ID card and request an operator. Altius Health Plans: HMO (PDF) - UT, ID (Southwest & Eastern), WY (Uinta County) HDHP (PDF) - UT, ID (Southwest & Eastern), WY (Uinta County) For information about our plans available through the Federal Employees Dental and Vision Insurance Program (FEDVIP), please visit our Dental PPO Plan site or our Aetna Vision Preferred plan site. 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. All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. Cigna DPPO networks offer convenient access to quality dentists all across the country and savings on covered dental services. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice.
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