You have three dental plan options. All are offered through Aetna and cover preventive care, basic care, major care, and orthodontia. The options include:
- Aetna Managed Dental Plan (DMO), which pays benefits only when you use network providers
- Aetna PDN (Low Option), which pays benefits in- and out-of-network.
- Aetna PDN (High Option), which pays benefits in- and out-of-network
For a list of Aetna dental network providers, go to www.aetna.com. Click here for instructions on how to locate a dental provider.
No ID Card Needed! You do not need a member ID card to get care with Aetna Dental. When you go to your dentist, just tell the office your name, date of birth, and Member ID# (or your social security number). If you would prefer to have a card, you may print one at www.aetna.com.
Accessing DMO services will be quicker if you designate a primary care dentist when you enroll.
Summary of Coverage
The table below summarizes how each plan covers dental expenses and shows what each plan pays.
|Plan Feature||Aetna Managed Dental Plan (DMO) In-Network only||Aetna PDN (Low Option) In-Network and Out-of-Network1||Aetna PDN (High Option) In-Network and Out-of-Network2|
|Deductible||None||$50 per person $150 per family||$50 per person $150 per family|
|Preventive Care: One visit every six months for routine checkups, X-rays, cleaning, and polishing||You pay a $5 copay||
You pay 10% with no deductible
|You pay $0|
|Basic Care: Fillings, extractions, root canal therapy, scaling of teeth, and basic oral surgery||You pay a fixed copay according to the plan’s schedule||You pay 40% after deductible||You pay 20% after deductible|
Major Care: Bridges, dentures, crowns, inlays, onlays, and complex oral surgery
|You pay a fixed copay according to the plan’s schedule||You pay 60% after deductible||
You pay 50% after deductible
*Implants are included in Major Care for this plan option
|Maximum Annual Benefit||No limit||$1,000 per person||$1,500 per person|
|Orthodontic Care3||You pay a $2,300 copay||50% with no deductible; $1,000 lifetime maximum||
50% with no deductible; $1,500 lifetime maximum
1 For the PDN (Low Option), fees are based on Aetna’s fee schedule, so your out-of-pocket expenses will be higher than those under the PDN (High Option).
2 Dental PDN network providers agree to charge discounted rates for their services. Although the coverage is the same for in-network and out-of-network care, out-of-network providers may charge higher fees than in-network providers, resulting in higher out-of-pocket expenses for you.
3 For eligible adults and dependent children.
Download the Aetna app on your mobile device to view claims, find a dentist, and access a variety of resources.
Dental Plan Summaries
- Enhanced Dental Benefits (for PDN plans)
- Additional benefits (for members that are pregnant, or have diabetes or heart disease)
Who do I contact with questions?
- Call Aetna at 1-877-MyTHRLink (1-877-698-4754) prompt 2, then 4
- Email THR Benefits Support at THRBenefitsSupport@texashealth.org.