Dental

You have two dental plans to choose from: the Dental Preferred Provider Organization (DPPO) Plan or the Dental Maintenance Organization (DMO) Plan. Both are administered by Aetna, and both are available as stand-alone plans, meaning you don’t have to enroll in other AMCN health care plans to join.

AMCN Benefits
$
Health
$
Dental

Find in-network providers

Log into your Aetna account to find a dentist.

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Contact Information

Aetna
aetnanavigator.com
Phone: 1-877-238-6200
Group #: 307285

Plan highlights

Both plans cover:

100% of the costs of in-network preventive care, like exams, cleanings, and x-rays.
Orthodontia for adults and children, up to certain limits.

Dental Preferred Provider Organization (DPPO) Plan

Annual deductible: You must meet the deductible for non-preventive services before the plan starts paying. Once you meet the deductible, the plan pays a percentage of the cost for services until the annual maximum is met.
Annual maximum: This is the most the plan will pay for dental expenses in one calendar year. Once the annual maximum is met, the plan does not pay benefits for the rest of the year.
In- and -out-of-network coverage: Includes in-network and out-of-network coverage, but you will generally pay less when you choose an in-network dentist.
No referrals or Primary Care Dentists (PCD) designation: You don’t need a referral to see any in-network dentist, and you don’t need to select a PCD.

Out-of-network coverage in the DPPO Plan

If you visit an out-of-network provider, the plan will pay benefits based upon a reduced fee schedule after you meet your deductible. You should review this fee schedule before receiving services from an out-of-network provider. You’re responsible for any provider charges not covered by the plan.

Dental Maintenance Organization (DMO) Plan

No annual deductible or annual maximum: There is no annual deductible to meet before the plan starts paying, and there’s no limit to how much the plan will pay for non-orthodontia dental expenses each calendar year.
In-network only coverage: The plan only covers dental expenses from in-network providers.

Required referrals and designated PCD: You must designate a DMO PCD, and referrals from your PCD are required to see a specialist. If you do not use your PCD or receive a referral from your PCD, you will pay 100% of the costs. You can select the same or different PCDs for each covered family member.

Compare dental plans

View the chart below to compare in-network costs. To compare per pay period contributions, visit Employee Contributions.

Some dental services may require pre-certification. To find out which services require pre-certification, view the Summary Plan Description or call Aetna at 1-877-238-6200.

	Dental PPO Plan	Dental DMO Plan
Annual deductible Individual	$50	None
Employee + 1 dependent	$100
Employee + 2 or more dependents	$150
Annual maximum	$2,000 per person	None
Orthodontia lifetime maximum	$2,000 per person	One course of treatment per person, per lifetime, no maximum
Primary care dentist referral	Not required	Required
Out-of-network coverage	Yes	No
Preventive care¹ Exams, cleanings, fluoride, and emergency treatment for dental pain	100%, deductible does not apply	100%
Basic services Fillings, stainless steel crowns, root canals², scaling and root planning, extractions, and denture repairs	80%, after deductible	100%
Major services Root canals, inlays, onlays, and bridges, crowns, dentures, implants³, surgical removal of impacted teeth²	50%, after deductible	60%
Orthodontia Adults and children	50%, up to $2,000 orthodontia lifetime maximum (deductible and annual maximum do not apply)	50% of one course of treatment per person, per lifetime

1 Frequency and age limitation apply to these services. Please contact Aetna Member Services directly for description of coverage.

2 Covered as a major service under the DMO. Dental PPO covers root canal therapy for molar teeth, osseous surgery and the surgical removal of a partial or full bony impact tooth as a basic service.

3 Dental PPO plan only.