Two Plans to Meet Your Needs
Aetna Individual Advantage Dental has two plans to meet your meets – the Aetna Individual AdvantageSM Dental PPO Plan and the Aetna Individual AdvantageSM Dental PPO Plus Plan. They both offer coverage for:
- Preventive care services such as cleanings, x-rays and more
- Basic care like fillings, simple extractions, root canals, basic restorative work and more
- Major services such as bridges, crowns, dentures and more
Additional Features of both Aetna Individual Dental Plans include:
- No underwriting required – plan is automatic issue
- Members who access participating PPO dentists will receive discounts (equal to the PPO negotiated rate) for non-covered services such as tooth whitening and adult orthodontics
- All Individual Advantage PPO Dental Plan members get access to Aetna’s Value Added Discount Programs.
- Members can save on: Vision, Natural Products and Services, Fitness, and discounts on Oral Health Care Supplies. In addition, discounts on vitamins, massage and acupuncture are also available
Difference Between Aetna PPO Plan and Aetna Advantage PPO Plus Plan
The difference between the two plans, Aetna Individual Advantage PPO Plan and the Aetna Individual Advantage PPO Plus Plan lies in the amount that each plan will pay for the covered services that the plan encompasses as illustrated in the table below. With the Plus Plan, Aetna will pay 100% of the cost of diagnostic and preventative services, while the Advantage PPO Plan will pay only 80%. For denture repairs, the plus plan will pay 80% while the regular plan will pay only 50%. When it comes to deductible (out of pocket) expenses, the Aetna PPO Plus Plan has a $50 deductible and the Advantage PPO Plan has a deductible of $100.
Aetna Individual Dental Plan Benefits
| Dental Services | Aetna PPO Plus Plan pays* | Aetna PPO Plan pays* |
|---|---|---|
| Preventive (no waiting period, deductible waived) | ||
| Diagnostic and preventive | 100% | 80% |
| Basic (6 month waiting period) | ||
| Periodontal maintenance cleanings | 80% | 50% |
| Denture repair, rebase, and relining | 80% | 50% |
| Basic restorative (fillings) | 80% | 50% |
| Oral Surgery | 50% | 50% |
| Endodontics (root canals) | 50% | 50% |
| Major (18 month waiting period) | ||
| Periodontics (gum disease) | 50% | 50% |
| Crown and cast restorations | 50% | 50% |
| Prosthodontics (dentures) | 50% | 50% |
| Deductibles and Maximums (per member) | ||
| Deductible (calendar year) | $50 | $100 |
| Maximum benefit (calendar year) | $1200 | $1000 |
2013 Illinois Plan Rates
Aetna prices these plans in two age groups – 49 and under and 50 or older.
| Aetna PPO Plus Plan Rates (per month) | Aetna PPO Plan Rates (per month) | |
|---|---|---|
| Ages 49 and Under – Zip Codes 60001 – 60899 | ||
| 1 Person | $37.99 | $26.92 |
| 2 People | $77.55 | $54.96 |
| Family | $128.97 | $91.73 |
| Ages 49 and Under – Zip Codes 60901- 62999 | ||
| 1 Person | $28.26 | $23.86 |
| 2 People | $57.30 | $48.44 |
| Family | $95.95 | $81.28 |
| Ages 50 and Over – Zip Codes 60001 – 60899 | ||
| 1 Person | $50.61 | $36.23 |
| 2 People | $96.15 | $68.84 |
| Family | $144.84 | $103.65 |
| Ages 50 and Over – Zip Codes 60901 – 62999 | ||
| 1 Person | $36.73 | $31.45 |
| 2 People | $69.79 | $59.75 |
| Family | $106.60 | $91.01 |
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