Aetna Dental® Direct Preferred PPO

Aetna Dental has over 60 years of experience offering dental benefits. With Aetna Dental Direct, you’ll get the coverage you need to keep your teeth healthy. The plan offers preventive treatment at 100% with no out of pocket cost. You can choose from one of the more than 420,000* dental providers nationwide. Caring for your teeth should never feel out of reach with Aetna Dental Direct.

100% coverage for preventive services when you see an in-network dentist
No waiting periods for preventive services
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

Benefit

In-network

Out-of-network**

Individual Annual Deductible

$50 Per Person

Family Annual Deductible

$150 Per Family

Annual Benefit Maximum

$1,250 Per Person

$1,250 or $1,000 depending on state

*Based on January 2023 Aetna provider data
**Out-of-network benefits vary by state and are subject to certain charge limits. You may be balance billed by out-of-network dentists — up to the dentist’s standard fee.
Deductible and annual maximum amounts cross-apply between in network and out of network. Deductible applies to basic and major services only.

Annual Maximum

This is the total amount per person your plan will pay toward the in-network cost of dental care each year.

$1,250 per enrollee on the plan

Deductible For Covered Services

$50 individual / $150 family per calendar year

Waiting Periods

After 6 months of continuous coverage under the PPO Plan: Resin filling (1 surface), periodontal maintenance cleanings, extraction (uncomplicated).
After 12 months of continuous cover under the PPO Plan: Oral surgery, crowns, root canal therapy, and dentures.
Waiting period is waived if all family members enrolling had dental coverage within the past 90 days
In Pennsylvania, the “waiting period” is called an “elimination period” and most Basic services have one month waiting period.

Choose any dentist

See dentists both in and out of our network. With our dental insurance plans for individuals, you can get services from either a participating or nonparticipating dentist. Participating dentists have agreed to provide services at a negotiated rate for covered services. You also have the flexibility to visit a licensed dentist who does not participate in our network. However, if you do this, you won’t benefit from negotiated rates.

Plan Highlights

Aetna Dental Direct Preferred PPO
Here is a sample of covered services	In-Network You Pay
Preventive services – Waiting period*: None
Preventive oral examinations	No Cost
Cleanings	No Cost
Full mouth series images	No Cost
Sealants (permanent molars only)	No Cost
Basic services – Waiting period*: 6 months
Resin filling (1 surface)	20%
Periodontal maintenance cleanings	20%
Extraction (uncomplicated)	20%
Major services – Waiting period*: 12 months
Oral Surgery	50%
Crowns	50%
Root canal therapy	50%
Dentures	50%
Orthodontics	not covered
Deductible (calendar year)**	$50 (Individual) \| $150 (Family)
Annual maximum benefit**	$1,250

**Deductible and Annual Maximum cross-apply between In-Network and Out-of-Network. Deductible applies to Basic & Major services only.

Start saving on your dental care today.

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Actual costs and savings may vary by provider, service and geographic location.

Dental insurance plans are underwritten by Aetna Life Insurance Company.

This is only a summary of the plan's exclusions and limitations. See the insurance policy for details.

Charges for services or supplies

Provided by an out-of-network provider in excess of the recognized charge.

Provided for your personal comfort or convenience, or the convenience of any other person, including a dental provider.

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.

Cancelled or missed appointment charges or charges to complete claim forms.

For which you have no legal obligation to pay.

In excess of the benefit, dollar, day, visit, or supply limits stated in your schedule of benefits.

That would not be made if you did not have coverage.

That are cosmetic in nature. Teeth whitening and facings on molar crowns and pontics will always be considered cosmetic.

That are experimental or investigational.

That are not medically necessary.

For prescribed drugs, pre-treatments or analgesia.

That are provided by a family member.

For work-related conditions.

For work that began before you were covered under the plan

The following dental services and supplies

Acupuncture, acupressure and acupuncture therapy

Crown, inlays and onlays, and veneers unless for one of the following:
- It is treatment for decay or traumatic injury and teeth cannot be restored with a filling material
- The tooth is an abutment to a covered partial denture or fixed bridge.

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

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

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

First installation of a denture or fixed bridge, and any inlay and crown that serves as an abutment to replace congenitally missing teeth or to replace teeth all of which were lost while the person was not covered

General anesthesia and intravenous sedation, unless specifically covered and only when done in connection with another eligible dental service

Instruction for diet, plaque control and oral hygiene

Orthodontic treatment except as covered in the Eligible Dental Services section of your insurance policy

Replacement of a device or appliance that is lost, missing or stolen, and for the replacement of appliances that have been damaged due to abuse, misuse or neglect and for an extra set of dentures

Replacement of teeth beyond the normal complement of 32

Services and supplies provided where there is no evidence of pathology, dysfunction or disease, other than covered preventive services

Surgical removal of impacted wisdom teeth when only for orthodontic reasons

Temporomandibular joint dysfunction/disorder.

Aetna Dental Direct PPO Plans are Subject to the Following Rules:

The replacement of; addition to; or modification of: existing dentures; crowns; casts or processed restorations; removable denture; fixed bridgework; or other prosthetic services is covered only if specific criteria are met.

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.

Alternate Treatment Rule

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 treatment is being given by a participating dental provider and the covered person asks for a more costly covered service than that for which coverage is approved, the specific copayment for such service will consist of:

the copayment for the approved less costly service; plus
the difference in cost between the approved less costly service and the more costly covered service.

Aetna Dental Savings Plans are NOT dental insurance and the dental savings will vary by provider, plan and zip code. Aetna dental plans are not considered to be qualified health plans under the Affordable Care Act. Please consult with the respective plan detail page for additional plan terms. The dental discounts are available through participating healthcare providers only. To check that your provider participates, visit our website or call us. Since there is no paperwork or reimbursement, you must pay for the service at the time it’s provided. You will receive the discount off the provider’s usual and customary fees when you pay. We encourage you to check with your participating provider prior to beginning treatment. Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. Note – not all Aetna dental plans and offers available in all markets.

Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. Note – not all plans and offers available in all markets.

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