How do I find a dentist?What services are covered?Can my kids get braces?
High Plan and Low Plan Options Ameritas Network
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Dental Plans |
Stay in network to save
Visit a dentist in the network to maximize your savings. These dentists have agreed to reduced fees, and you won't get charged more than your expected share of the bill. Find a dentist at aetna.com/individuals-families/find-a-doctor.html. When sure to select "Dental PPO/PDN with PPO II and Extend" as the plan name when searching.
Out-of-network Coverage
A dentist who is “out-of-network” means the provider hasn’t agreed to negotiated rates. The plan pays benefits based on a Fee Schedule charge for a particular service. If the out-of-network provider charges more, you’ll be responsible for paying the amount that exceeds the Fee Schedule limit plus the applicable coinsurance and deductible.
Visit a dentist in the network to maximize your savings. These dentists have agreed to reduced fees, and you won't get charged more than your expected share of the bill. Find a dentist at aetna.com/individuals-families/find-a-doctor.html. When sure to select "Dental PPO/PDN with PPO II and Extend" as the plan name when searching.
Out-of-network Coverage
A dentist who is “out-of-network” means the provider hasn’t agreed to negotiated rates. The plan pays benefits based on a Fee Schedule charge for a particular service. If the out-of-network provider charges more, you’ll be responsible for paying the amount that exceeds the Fee Schedule limit plus the applicable coinsurance and deductible.
LOW DENTAL PLAN (90TH R&C)
PPOII AND EXTEND NETWORK
PPOII AND EXTEND NETWORK
In-Network
Out-of-Network*
Annual Deductible
Jan 1 - Dec 31
Jan 1 - Dec 31
You pay up to
$50 per individual / $150 per family
$50 per individual / $150 per family
Annual Maximum
Jan 1 - Dec 31
Jan 1 - Dec 31
Plan pays up to
$1,250 per individual
$1,250 per individual
Waiting Period
None for Preventive, Basic, or Major Services
Preventive Services
Cleanings, Exams, Fluoride (for children up to age 16), Sealants, Space Maintainers, and X-rays
Cleanings, Exams, Fluoride (for children up to age 16), Sealants, Space Maintainers, and X-rays
Plan pays
100% of covered services
No Deductible Applies
100% of covered services
No Deductible Applies
Plan pays
100% of R&C
No Deductible Applies
100% of R&C
No Deductible Applies
Basic Services
Endodontics, Extractions, Fillings, General Anesthesia, and Periodontics
Endodontics, Extractions, Fillings, General Anesthesia, and Periodontics
Plan pays
80% AD
80% AD
Plan pays
80% of R&C, AD
80% of R&C, AD
Major Services
Bridges, Crown Repairs, Crowns, Dentures, Implants, Inlays, and Onlays
Bridges, Crown Repairs, Crowns, Dentures, Implants, Inlays, and Onlays
Plan pays
50% AD
50% AD
Plan pays
50% of R&C, AD
50% of R&C, AD
Orthodontic Services
Not covered
Not covered
Orthodontic Lifetime Maximum
Not covered
AD: After Deductible
R&C: Reasonable & Customary fees
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
R&C: Reasonable & Customary fees
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
EMPLOYEE COST PER PAY PERIOD
Employee Only
Employee + One Dependent
Employee + Family
$0.00
$5.00
$10.00
Tax considerations for Domestic Partners: You pay for health coverage before federal, state and social security taxes are withheld, you you pay less in taxes. Please note that Domestic Partner contributions are regulated by the IRS and generally must be made on an after-tax basis. Similiary, the company contribution toward the cost of the domestic partner coverage and his/her dependents is taxable income to you. Please contact your Tax Advisor for more details on how this tax treatment applies to you, if applicable.
Stay in network to save
Visit a dentist in the network to maximize your savings. These dentists have agreed to reduced fees, and you won't get charged more than your expected share of the bill. Find a dentist at aetna.com/individuals-families/find-a-doctor.html. When sure to select "Dental PPO/PDN with PPO II and Extend" as the plan name when searching.
Out-of-network Coverage
A dentist who is “out-of-network” means the provider hasn’t agreed to negotiated rates. The plan pays benefits based on a Fee Schedule charge for a particular service. If the out-of-network provider charges more, you’ll be responsible for paying the amount that exceeds the Fee Schedule limit plus the applicable coinsurance and deductible.
Visit a dentist in the network to maximize your savings. These dentists have agreed to reduced fees, and you won't get charged more than your expected share of the bill. Find a dentist at aetna.com/individuals-families/find-a-doctor.html. When sure to select "Dental PPO/PDN with PPO II and Extend" as the plan name when searching.
Out-of-network Coverage
A dentist who is “out-of-network” means the provider hasn’t agreed to negotiated rates. The plan pays benefits based on a Fee Schedule charge for a particular service. If the out-of-network provider charges more, you’ll be responsible for paying the amount that exceeds the Fee Schedule limit plus the applicable coinsurance and deductible.
HIGH PLAN - AMERITAS NETWORK
In-Network
Out-of-Network*
Annual Deductible
Jan 1 - Dec 31
Jan 1 - Dec 31
You pay up to
$50 per individual / $150 per family
$50 per individual / $150 per family
Annual Maximum
Jan 1 - Dec 31
Jan 1 - Dec 31
Plan pays up to
$1,750 per individual
$1,750 per individual
Waiting Period
None for Preventive, Basic, Major or Orthodontic Services
Preventive Services
Cleanings, Exams, Fluoride (for children up to age 16), Sealants, Space Maintainers, and X-rays
Cleanings, Exams, Fluoride (for children up to age 16), Sealants, Space Maintainers, and X-rays
Plan pays
100% of covered services
No Deductible Applies
100% of covered services
No Deductible Applies
Plan pays
100% of R&C
No Deductible Applies
100% of R&C
No Deductible Applies
Basic Services
Endodontics, Extractions, Fillings, General Anesthesia, and Periodontics
Endodontics, Extractions, Fillings, General Anesthesia, and Periodontics
Plan pays
90% AD
90% AD
Plan pays
90% of R&C, AD
90% of R&C, AD
Major Services
Bridges, Crown Repairs, Crowns, Dentures, Implants, Inlays, and Onlays
Bridges, Crown Repairs, Crowns, Dentures, Implants, Inlays, and Onlays
Plan pays
60% AD
60% AD
Plan pays
60% of R&C, AD
60% of R&C, AD
Orthodontic Services
Child(ren) up to age 19
Child(ren) up to age 19
Plan pays up to
50%
No Deductible Applies
50%
No Deductible Applies
Plan pays up to
50% of R&C
No Deductible Applies
50% of R&C
No Deductible Applies
Orthodontic Lifetime Maximum
$1,500 per child (up to age 19)
AD: After Deductible
R&C: Reasonable & Customary fees
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
R&C: Reasonable & Customary fees
* Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.
EMPLOYEE COST PER PAY PERIOD
Employee Only
Employee + One Dependent
Employee + Family
$9.16
$21.43
$36.12
Tax considerations for Domestic Partners: You pay for health coverage before federal, state and social security taxes are withheld, you you pay less in taxes. Please note that Domestic Partner contributions are regulated by the IRS and generally must be made on an after-tax basis. Similiary, the company contribution toward the cost of the domestic partner coverage and his/her dependents is taxable income to you. Please contact your Tax Advisor for more details on how this tax treatment applies to you, if applicable.
This information is designed to help you choose a benefit plan for 2025 only. Please refer to the Plan Documents provided by the carrier for details regarding coverage, limitations and exclusions. If there is a difference between this guide and the Plan Documents, the Plan Documents prevail.
