Dental coverage is available for all Active, Full COBRA and Non-Medicare Retirees only.
- You can choose an Aetna PPO dentist or a non-network dentist.
- Your costs are generally lower when you use an Aetna PPO dentist.
|Calendar Year Maximum||$2,000/person (does not apply to children under age 19)|
|Lifetime Orthodontia Maximum (orthodontic)||$5,000/eligible child under age 19|
|Type of Care||Plan Pays||You Pay|
|Diagnostic/Preventive (e.g., cleanings, x-rays)||100%||0%|
|Orthodontics (for enrolled children under age 19)||80%||20%|
Predetermination of Dental Benefits
Before beginning a course of treatment for which dental charges are expected to exceed $500, a description of the proposed services and supplies and the estimated charges should be submitted to Aetna. You and your dentist will then be notified by Aetna of the amount of the benefit payable for the proposed course of treatment.
Orthodontic Services (for eligible dependent children up to age 19 ONLY)
The Orthodontic Benefit pays 80% of the allowable dental fees, up to a lifetime maximum of $5,000 for orthodontic services that Aetna has approved.
The Orthodontic Benefit will be paid for your eligible dependents up to age 19. Covered charges will be payable in equal quarterly installments of 80% of the allowable charge incurred throughout the estimated duration of the treatment plan, up to a lifetime maximum benefit of $5,000. However, the initial payment for charges related to the installation of an appliance will be limited to 25% of the total allowable charge incurred for the course of treatment.
Temporomandibular Joint Dysfunction Benefit (TMJ)
The Fund will provide payment for diagnosis, x-rays, consultation, appliances, and treatment for TMJ at 80% of the allowable charges that have received Aetna’s managed care approval.
The TMJ Benefit is the only payment for TMJ provided by the Fund. TMJ coverage is not provided under any other benefit available under the Plan, including Medical Expense Benefits or Dental Expense Benefits.
Dental Benefits Summary
Schedule of Benefits, effective August 1, 2022
Schedule of Benefits January, 2023
Schedule of Benefits January 2023 – Spanish
Orthodontic Benefit Improvements, effective June 1, 2022