Aetna Dental Welcomes Rollins College

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Title:

Aetna Dental Welcomes Rollins College

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... Aetna DMO/PPO Max & Indemnity Dental Plans. DMO/PPO Max/Indemnity. Rollins ... Approximately 6,800 available dental office locations and approximately 17,000 ... – PowerPoint PPT presentation

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Title: Aetna Dental Welcomes Rollins College


1
Aetna Dental Welcomes Rollins College

2
Introducing Aetna DMO/PPO Max Indemnity Dental
Plans
  • DMO/PPO Max/Indemnity

3
DMO Facts
  • Approximately 6,800 available dental office
    locations and approximately 17,000 individual
    practitioners
  • Primary care dentist selection required
  • Change dentist by 15th of month effective 1st
    the following month
  • 5 office visit copayment per visit
  • Member pays copayments for all services
  • Specialty referral required (except
    orthodontists)
  • Orthodontia covered for adults and children
  • Members receive ID cards
  • No deductibles, maximums or claims forms
  • Internet access to provider information DocFind
  • Styles of Practice
  • Out of Network Coverage only
  • Pre-Determination for anything over 300.00
  • One time emergency authorization available

4
Dental PPO Max Facts
  • Go to any dentist
  • Use Participating PPO Dentist - No Balance
    Billing
  • Claims are paid based on fee-scheduled amounts
    for the Central Florida area
  • Non-PPO Dentist can charge above fee-schedule
    member can be balanced billed
  • Lowest out of pocket costs when using PPO
    Dentists

5
Dental PPO Max Plan
  • Annual Deductible
  • Individual
    50

  • Family 150
  • Preventive Services
    100 of fee schedule
  • Basic Services
    80 of fee schedule
  • Major Services
    50 of fee schedule
  • Annual Benefit Maximum 1000
  • Orthodontia for adults and children 50
  • Orthodontia Lifetime maximum 1000
  • No deductible for orthodontia
  • Deductible applies to Basic Major services
    only
  • -Non network claims paid at the fee-scheduled
    amount

6
Dental PPO Max Plan
  • Important Information
  • Fee Schedule is based on Contracted Rates with
    PPO Dentists NOT Reasonable and Customary Charges
  • Example
  • John goes to a participating dentist for a
    crown
  • Scheduled PPO Amount for Procedure 2750 (crown)
    551
  • Assume Deductible Has Been Met
  • Plan pays 50 of Maximum PPO Allowance
    275.50
  • Member pays 275.50

7
Dental PPO Max Plan
  • Important Information
  • Fee Schedule is based on Contracted Rates with
    PPO Dentists NOT Reasonable and Customary Charges
  • Example
  • John goes to a non-participating dentist for a
    crown
  • Scheduled PPO Amount for Procedure 2750 (crown)
    551
  • Non-participating dentist charges
    700
  • Assume Deductible Has Been Met
  • Plan pays 50 of Maximum PPO Allowance
    275.50
  • Member pays 700.00(Dentist Charge)-275.50(Maxi
    mum PPO Allowance) 424.50

8
Indemnity Dental Plan
  • Go To Any Dentist
  • Plan pays at Reasonable Customary (80th
    Percentile)
  • Deductible 75.00/150 Family
  • Preventive Services 100 of R C
  • Basic Service 80 of R C
  • Major Services 50 of R C
  • Annual Maximum 1000
  • Orthodontic Services 50
  • Orthodontic Lifetime Maximum 1000

9
Dental Plans Monthly Cost To Employees
  • DMO
  • Employee Only 0.00
  • Employee Spouse 10.84
  • Employee Child(ren) 18.29
  • Family 29.19
  • PPO Max
  • Employee Only 12.52
  • Employee Spouse 36.65
  • Employee Child(ren) 35.02
  • Family 54.88
  • Indemnity Dental
  • Employee Only 20.19
  • Employee Spouse 52.14
  • Employee Child(ren) 49.98
  • Family 76.29

10
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11
Free Vision Discounts with all plans Vision One
12
? Questions ?