Update on Retiree Dental Coverage


·         In network –When care is provided by an Aetna network provider you will receive the highest level of compensation for covered dental services.

·         Out of network- When care is provided by an out of network provider you will still see an improvement in the useable dollars available to you (compared to the current indemnity plan) but it may not be as favorable as in network for covered dental services.

·         You are not required to use a network provider

Billed Charges/Fees-  

The Indemnity Plan (the old plan) was based on a fee schedule which was set by Vz. This was simply the amount Vz wanted to pay for each procedure code.

The PPO plan is based on in or out of network.

·         In network charges are a discounted fee agreed to by the provider with Aetna.

·         Out of network charges are based on reasonable and customary (R&C) charges.

Please see the 2016 MOU (under the Contract>Verizon tab) for more details.

Coverage Overview-

·         $50 annual deductible/individual, $100 family (in or out of network)

·         Preventative and Diagnostic Services- (ie: oral exam, cleanings, x-rays, fluoride, sealants….see MOU for details)

o   100%-  in or out of network

o    no annual deductible

·         Basic Restorative Services-(i.e.: fillings. Routine extractions, oral surgery, molar root canal, periodontics)

o   80% in-network of network charge

o   50% out of network R&C  

·         Major Restorative Services- (i.e.: crowns, dentures, bridges, implants)

o   50% in-network of network charge

o   50% out of network R&C

·         Orthodontia Services-

o    50% in network of network charge

o    50% out of network R&C (up to $2,000 lifetime max per individual)

·         $1500 annual maximum benefit (unchanged)

·         The new plan and plan design improve the usability of the yearly $1500 benefit

Pre-Determination of coverage-

It is always best to request a pre-determination of benefits before having dental work done in order to understand the charges which are covered and what your responsibility will be. Your provider may call Aetna while you are at the office to get information or submit it electronically if services are not occurring that same day.