Aetna Dental PPO Plans — High and Low Options

As with any PPO plan, the Aetna Dental PPO plans are designed to provide you with a greater level of coverage for using service providers within the Aetna network. Some coverage is available for providers outside the Aetna network; however any services you receive from an out‐of‐network provider will be paid only at the “Reasonable and Customary” amount.

The High Option provides you with a greater level of coverage, and therefore carries a higher premium. The Low Option provides you with preventive and basic coverage and has a lower premium. 

Aetna Dental Maintenance Organization (DMO)

You also have the option of selecting coverage through the Aetna DMO, which provides benefits in a similar manner to an HMO medical plan. You must elect a Primary Care Dentist (PCD) from within the Aetna network to coordinate all your dental care. If your PCD believes you need to visit a dental specialist, he or she will refer you to a specialist in the DMO network. The DMO does not provide coverage outside the Aetna network.

There is no deductible to meet under the DMO, nor is there an annual maximum coverage amount. Office visits require a $5 co‐payment in addition to the fixed‐dollar member cost sharing that applies for most covered dental services. Member cost‐sharing amounts are listed in the DMO Benefits Summary. Orthodontic services are available for both adults and children, and require a $2,300 copay.