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. 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. You get access to discounts off the regular charge on products and services offered by third-party vendors and providers. are covered at 100% on most plans. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. You can also download it from the App Store or the Google PlayTM store. That are not medically necessary. Aetna Invisalign Coverage Your Aetna plan might cover your Invisalign treatment, although it depends entirely on the plan. Members must make payments directly to the providers in the Aetna Vital Savings program. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating 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. Aetna will expand the Total Choice dental benefit introduced in 2022 to additional Individual MA HMO-POS and PPO plans. ChooseHealthy is a federally registered trademark of ASH and used with permission herein. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. So, your share of the cost is usually lower. To view the form just select Continue. Are there any waiting periods? 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. You may also be required to pay a portion of the costs. 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. ** Out-of-network benefits are paid based on recognized charge levels, as determined by Aetna and specified in your plan documents. Insurer Name: Aetna Life Insurance Company Plan Name: Aetna Dental PPO Policy Type: PPO Insurer Phone #: 1-877-238-6200 Effective Date: 01/01/2022-12/31/2022 Insurer Website: www.aetna.com THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND WHAT YOU WILL PAY FORCOVERED SERVICES. Youre given an annual allowance to spend on dental care. When you have an Aetna Dental plan, you know youre taking the right steps toward being healthy. Provider Directory Last Updated: April 22, 2023 Page Last Updated: January 27, 2023 Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Top 3 reasons to choose Aetna Dental 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. Important Disclaimers for Medicare Members For questions on your dental benefits, call us 1-866-409-0937 (TTY: 711). For additional language assistance: Choose from more than 120,000 dental providers nationwide, including providers who offer virtual visits through tele-dentistry. Use order code 123AET200. Dental plans are all different. Get the Aetna Health app by texting GETAPP to 90156 for a link to download the app and create an account. And you dont have to have Aetna medical or other coverage with us to purchase. The plan offers preventive treatment at 100% with no out of pocket cost. Do you cover adult orthodontia? Aetna Dental Direct PPO Plans are Subject to the Following Rules: Replacement Rule Enjoy discounts on hearing aids, exams and hearing aid batteries mailed to your home. Deductible: the dollar amount some plans require you to pay for services before coverage starts. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Privacy policy: Aetna.com/legal-notices/privacy.html. 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. 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. Members should discuss any matters related to their coverage or condition with their treating provider. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Aetna Dental has over 60 years of experience offering dental benefits. Services and supplies provided where there is no evidence of pathology, dysfunction or disease, other than covered preventive services There are no claims or referrals to worry about, and no limits on how much you can save. Premium deductions will start with the first full pay period The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Everyone can get their own in-network primary care dentist. You also have the flexibility to visit a licensed dentist who does not participate in our network. This is only a summary of the plan's exclusions and limitations. 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. Visit your PCD: If you see someone other than your selected PCD, you could end up paying more. Network dentists also file claims for you. Information is believed to be accurate as of the production date; however, it is subject to change. 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. See your PCD for regular exams and to get referrals if you need specialty care. Preventive services (cleaning, x-rays, exams, etc.) Pay less for acupuncture,* chiropractic visits, therapeutic massage and nutrition services** and for products like wearable fitness devices and fitness kits. Aetna will continue to offer most Medicare Advantage members access to routine vision, dental and hearing coverage. - The tooth is an abutment to a covered partial denture or fixed bridge. A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl. We make dental care convenient. 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. All Rights Reserved. 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). How to enroll: Once youre a member, heres how you can connect: 1. Links to various non-Aetna sites are provided for your convenience only. 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. You are leaving our Medicare website and going to our non-Medicare website. Weve broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. If you do not intend to leave Aetna Medicare, close this message. All services deemed "never effective" are excluded from coverage. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Selection of a program provider is also the responsibility of the participant and is not based on any representations by Aetna. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. 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. So, you wont see cost information here. *Acupuncture is an essential health benefit, and the discount for this service may duplicate benefits if you are enrolled in a full-service plan. This may be a copay, which is a set dollar amount. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts. . Student health insurance plans are underwritten by Aetna Life Insurance Company (Aetna). Aetna Dental Direct insurance plan is offered by Aetna Life Insurance Company (Aetna). Certain preventive care services are covered at little-to-no-extra cost 2 when . 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. 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 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. Links to various non-Aetna sites are provided for your convenience only. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. New and revised codes are added to the CPBs as they are updated. You can start using your plan right away! 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. Visit the secure website, available through www.aetna.com, for more information. For language services, please call the number on your member ID card and request an operator. Im turning 65 or just starting to explore Medicare. 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. Thats it. There also may be age and frequency limits on some services. 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. View your plan details. 4. . Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. Acupuncture, acupressure and acupuncture therapy 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. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. This is donethrough an optional supplemental benefit. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Please log in to your secure account to get what you need. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Be sure to make copies of all of your paperwork. Your InstaMed log in may be different from your Caremark.com secure member site log in. Treating providers are solely responsible for medical advice and treatment of members. 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 five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. If you do not intend to leave our site, close this message. If you do not intend to leave our site, close this message. Compare our plans and find the coverage that's best for you. You may pay more when you get care from dentists who arent in the network.**. SBBC now offers the option of four dental plans available from three dental carriers. Pricing starts at $20 in most regions, and also includes: No waiting periods Inclusive plans. General anesthesia and intravenous sedation, unless specifically covered and only when done in connection with another eligible dental service 5. Understand the link between infections in the mouth, and their impact on other parts of the body. ZIP CODE View 2023 plans Learn about these benefits Dental, eyewear and hearing coverage is available. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. 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. your primary care dentist will refer you to one in our network. 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 . CPT is a registered trademark of the American Medical Association. The plan offers preventive treatment at 100% with no out of pocket cost. Caring for your teeth should never feel out of reach with Aetna Dental Direct. Aetna dental insurance comes with stand-alone dental coverage or dental, vision, and hearing coverage. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Aetna handles premium payments throughInstaMed, a trusted payment service. Each main plan type has more than one subtype. They also have Direct Preventive, which only covers the costs of preventive dental care. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). Si tu intencin no era salir del sitio web, cierra este mensaje. Instruction for diet, plaque control and oral hygiene Some subtypes have five tiers of coverage. Treating providers are solely responsible for medical advice and treatment of members. In excess of the benefit, dollar, day, visit, or supply limits stated in your schedule of benefits. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. 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. Aetna does not endorse any vendors, products or services associated with this program. Remember Username Secure Login First time here? 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. 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. Save on popular designer frames*** and vision items that dont need a prescription. You can visit national chains and thousands of doctors in private practice. Aetna Direct Core PPO comes with lower premiums, and Direct Preferred PPO provides more favorable splits in payment for basic procedures like fillings and extractions. So your share of the cost is usually lower. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. Print dental claim form (English) Special perks and discounts, including exclusive offers from CVS Health, Search for providers in-network by using our. 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. Aetna Student Health Agency Inc. is a duly licensed broker for student accident and health insurance in the Commonwealth of Massachusetts. There also may be age and frequency limits on some services. There is one exception, however:If you needmedicaldental procedures whileyourein the hospital, Medicare may pay for those services as part of Medicare Part A (hospital insurance). You can change your PCD once a month on your member website. California license number: OB84599. Deductible applies to basic and major services only. 2022 . Persons with a hearing or speech disability can use 711 for Telecommunications Relay Service (TRS). 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. 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. 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. So, your share of the cost is usually lower. 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. 1999- Cigna DPPO networks offer convenient access to quality dentists all across the country and savings on covered dental services. Reprinted with permission. Learn about Medicare Advantage This Aetna Dental Preferred Provider Organization (PPO) benefits summary is provided by Aetna Life Insurance Company for some of the more frequently performed dental procedures. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. For work-related conditions. Some plans cover comprehensive services. Please consult with the respective plan detail page for additional plan terms. 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). The member's benefit plan determines coverage. By submitting your information you are agreeing to receive communications from Aetna Dental Offers. Want to learn more about your dental coverage? The Aetna Dental Direct plan covers preventative care 100% with no out of pocket cost. The AMA is a third party beneficiary to this Agreement. Shop around different dental care providers in your area to compare costs and make the best use of your annual allowance. Visit a dentist in the Aetna Dental PPO* network. For more information, please call HSA Consulting Customer Service at (888) 978-8355. 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. Links to various non-Aetna sites are provided for your convenience only. 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 Dental PPO insurance plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Studies show that a healthy mouth helps you avoid health problems in the body, too. Claim FAQ. All three plans are available in all 50 states and D.C and feature increased formulary coverage from 2022. We're here 8 a.m. - 8 p.m., Monday through Friday. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Links to various non-Aetna sites are provided for your convenience only. Choose from leading manufacturers and get free follow-up service for one year. Aetna Vital Savings provides participants with access to a network of independent practicing providers. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Click here to review plans with a $0 deductible. Members should discuss any matters related to their coverage or condition with their treating provider. Learn more about our network and DMR plans Search other providers Need a provider directory? Dental insurance plans are underwritten by Aetna Life Insurance Company. Find the right plans and programs for you. 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 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. And you don't have to have Aetna medical or other coverage with us to purchase. Deductible and annual maximum amounts cross-apply between in network and out of network. 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 The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. The plan offers both network (DMO) or out-of-network (PPO) coverage. It is only a partial, general description of plan or program benefits and does not constitute a contract.
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