There are three baisc types of dental benefits and dental insurance plans

  • Dental Maintenance Organization(DMO®)*
  • Preferred Provider Organization (PPO) or Participating Dental Network (PDN)**
  • Dental Indemnity

Here's a chart to help you learn the differences:

 

DMO

Dental PPO or PDN

Dental Indemnity

Plan description

A lower-cost dental benefits plan that gives you cost-effective care through a primary care dentist (PCD). You get the advantage of building a relationship with your PCD.

Visit any licensed dentist to receive benefits. You will typically enjoy lower costs if you choose a dentist who participates in our PPO/PDN network. There is never a need for a referral.

The freedom to visit any licensed dentist, anywhere in the country. No need to choose a PCD.  There is never a need for a referral.

Plan options

Copay – you pay a set dollar amount at the time of service;  or Coinsurance – you pay a percentage of covered expenses at the time of service.

Coinsurance – you pay a percentage of covered expenses at the time of service.

Coinsurance – you pay a percentage of covered expenses at the time of service.

Primary Care Dentist election

Yes – Call the dentist to ensure he or she is accepting new patients.

Not required

Not required

It’s easy to find a participating dentist. Just visit DocFind®, our online directory at www.aetna.com. Or call Member Services at 1-877-238-6200 .

Office visit copay – the amount you pay each time you visit the dentist for any procedure.

$0 to $15 depending on your plan.

None

None

Deductible – the amount you pay before your plan pays.

None – There is just a copay to pay. You do not have a plan deductible.

Yes – There is a deductible for procedures not covered at 100%. That means you pay a dollar amount before the plan starts to pay.

Yes – There is a deductible for procedures not covered at 100%. That means you pay a dollar amount before the plan starts to pay.

Annual maximum – the maximum amount your plan will pay out in a plan year.

None – Aetna DMO plans do not have an annual maximum limit. The plan continues to pay benefits for covered procedures throughout the plan year.

Yes – There are limits to how much Aetna will pay in benefits for covered procedures in a plan year.

Yes – There are limits to how much Aetna will pay in benefits for covered procedures in a plan year.

Referrals – the primary care dentist directs you to seek dental care from another dental professional.

Referrals are required, except when you visit an orthodontist in our DMO network.

None required

None required

Procedures NOT covered by the plan

You are responsible for the cost of procedures not covered by your plan.

You are responsible for the cost of procedures not covered by your plan. And remember this: Participating PPO and PDN dentists offer discounts on procedures not covered by your plan.

You are responsible for the cost of procedures not covered by your

Nexus Benefits Health Insurance