Here’s something to chew on: You have two dental plans to choose from, both through Aetna and both offering you plenty of reasons to smile. The main difference between the Base and Premium plan is that the Base plan doesn’t cover major services or — brace yourself! — orthodontia.
Highlights
Here’s how the two plans differ:
- The Premium Dental Plan offers expanded benefits for using providers in Aetna’s dental network. That includes lower coinsurance and deductibles and more coverage for basic and major services.
- The Base Dental Plan emphasizes prevention and is best if you anticipate only needing basic treatments (for example, amalgam fillings for cavities and broken teeth, as well as root canal therapy). Major services and orthodontia are not covered under the plan.
Dental Plans at a Glance
Here’s a high-level listing of commonly covered dental benefits. For more information, refer to the summary of benefits for these plans.
| Premium Dental Plan | Base Dental Plan (In-network only) |
|
|---|---|---|
| Annual Deductible What you pay out of pocket before your insurance starts paying its share of your cost |
In-network: $50 per person / $150 for family Out-of-network: $75 per person / $225 for family |
$50 per person $150 for family |
| Annual Benefit Maximum The most the insurance carrier will pay in a year for dental costs |
$2,000 per person (excludes orthodontia) | $750 per person |
| Preventive/Diagnostic Care (includes routine exams, cleanings and X-rays) |
100% of recognized charge (RC), no deductible | 100% of RC* |
| Basic Services (includes fillings, root canal therapy and extractions) |
In-network: Plan pays 90% of RC after deductible Out-of-network: Plan pays 80% of RC after deductible |
50% of RC after deductible |
| Major Services (includes inlays, onlays, crown restorations, removable dentures, and general anesthetics) |
In-network: Plan pays 60% of RC after deductible Out-of-network: Plan pays 50% of RC after deductible |
No coverage |
| Orthodontia Lifetime maximum is the total amount the insurance carrier will pay per person (includes adults) |
Plan pays 50% of RC after deductible, up to $2,000 per person’s lifetime | No coverage |
* The fees your dentist charges for these services (and that are covered 100% under the plan) do not count toward your annual benefit maximum.
Preventive, Basic and Major Services
What’s the difference between preventive/diagnostic care, basic services and major services? Here are some examples of what’s covered:
Preventive/Diagnostic Care
- Routine oral exam
- Prophylaxis (cleaning)
- Vertical and bitewing X-rays
- Fluoride treatment
- Installation and adjustment of space maintainers
Basic Services
- Amalgam fillings for cavities and broken teeth
- Visits and consultations
- Root canal therapy (anterior/bicuspid)
- Extractions, except when done in connection with orthodontic services
- Alveoplasty and tooth replantation
- Treatment of gum disease is limited to gingivectomy, gingival curettage, osseous surgery, and pedicle soft tissue grafts
Major Services
- Inlays, onlays, and crown restorations of broken or diseased teeth
- Repair of bridges
- Treatment of temporomandibular joint dysfunction
- Installing removable dentures
- Installing bridgework
- Replacing removable dentures or fixed partial dentures
- General anesthetics
- One reline or rebase of dentures covered in any 36 consecutive month period
- Molar root canal therapy