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2018 Biweekly rates for zip code

Aetna Dental PPO Self Only Self + 1 Self & Family
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Click here for the Dental plan summary pdf

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Benefit highlights

Dental Plan details Payment details
Yearly deductible $0
Yearly benefit maximum
per member
  • In network: $25,000
  • Out of network: $2,000
Class A (preventive) services
Like cleanings and X-rays
Plan pays 100%*
Class B (minor) services
Like fillings and simple extractions
Plan pays 60%*
Class C (major) services
Like crowns, root canals, dentures
Plan pays 40%*
Class D (Orthodontia) services - Braces**
Lifetime maximum per member**
Plan pays 50%*
*If you use an out-of-network dentist, you are responsible for the difference between our plan allowance and the dentist's charges.
**Covered after continuous enrollment in plan for 12 months.

Dental benefits are offered, underwritten and/or administered by Aetna Life Insurance Company (Aetna).

This material is for information purposes only. Not all dental services are covered. See FEDVIP brochure (PDF) for a complete description of benefits, exclusions, limitations and conditions of coverage. Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Information is believed to be accurate as of the production date; however, it is subject to change.