New Jersey State Health Benefits Program

Retiree DPO (Dental Plan Organization)*

AETNA RETIREE DPO = AETNA RETIREE DMO

Easy-to-use nationwide coverage to fit your budget

The Aetna Retiree DPO is affordable with a lower monthly premium. Aetna’s DMO networks are available to retirees nationwide. There are no claim forms to fill out and no deductibles to pay. Each covered family member must select a participating Primary Care Dentist (PCD) to coordinate all dental care.

How the Aetna Retiree DPO Plan works:

Step 1: Understand your benefit tier.

• Tier 3 — If you had dental coverage
  • Were you covered by another group dental plan for at least 12 months within 60 days before you signed up for the Retiree DPO Plan? If the answer is yes, you’ll be placed in Tier 3, the highest benefit tier.
• Tier 1 — If you did not have dental coverage
  • You were not covered by a group dental plan for at least 12 months within 60 days before you signed up for the Retiree DPO Plan. Right? So you’ll be placed in Tier 1, the lowest benefit tier. After a year in the plan, you’ll be placed in Tier 2. And after another year, you’ll move to Tier 3, which is the highest benefit tier

Step 2: Choose a primary care dentist (PCD) from the nationwide Aetna network.

• Your dental care begins with your PCD. He or she will help you learn about your dental health and how to manage it. Click here to find a dentist now!
• Choosing a dentist is a personal decision. That’s why each family member has his or her own PCD.
• You can change your PCD as often as once a month. Just call Member Services at the number on your Aetna member ID card by the 15th of the month to make your change effective by the first day of the following month.**

Step 3: Pay your share of the cost.

• Pay your copay. A copay is the fixed dollar amount you pay when receiving care. It is based on the type of service you have performed†.
• Pay your copay for services other than diagnostic or preventive.
• There is no deductible — and there are no annual dollar limits.
• You will not need to complete any claim forms.

*In Illinois, the Dental DMO plan provides limited out-of-network benefits. However, in order to receive maximum benefits, members must select and have care coordinated by their PCD. In Illinois, the Dental DMO plan is not an HMO.

**Your PCD keeps a list of eligible patients that is updated monthly. As long as you contact Member Services by the 15th of the month, your name will appear on this list the month after your selection. Some dentists will only treat patients whose names appear on this printed monthly roster. Once you are a member, you can call Member Services if your doctor needs to verify your eligibility.

† A full list of copayments is located in the Retiree Dental Plans Member Handbook.

 

Do you know what plan you want?

Retiree DEP (Dental Expense Plan)

AETNA RETIREE DEP = AETNA RETIREE DENTAL PPO

Freedom to choose any dentist

A plan exclusively offered to you by Aetna. This nationwide plan is great for members who like the freedom to go in and out-of the Aetna network.

Ah, Freedom! See any licensed dentist you choose!

• No referrals required.
• No need to choose a primary care dentist.
• Affordable coverage for cleanings, X-ray, restorative work and more.
• Choose from a nationwide network of participating dentists.

 

How the Aetna Retiree DEP Plan works:

Step 1: Understand your benefit tier.

• Tier 3 — If you had dental coverage
  • Were you covered by another group dental plan for at least 12 months within 60 days before you signed up for the Retiree Dental Expense Plan? If the answer is yes, you’ll be placed in Tier 3, the highest benefit tier.
• Tier 1 — If you did not have dental coverage
  • You were not covered by a group dental plan for at least 12 months within 60 days before you signed up for the Retiree Dental Expense Plan. Right? So you’ll be placed in Tier 1, the lowest benefit tier. After a year in the plan, you’ll be placed in Tier 2. And after another year, you’ll move to Tier 3, which is the highest benefit tier

Step 2:Decide if you want to go in-network or out-of-network for your care.

• You have the freedom to choose any dentist — in or out of the Aetna network. But, with so many dentists and specialists in the network, chances are your doctor is one of them. You can find out right now! Click here to locate a dentist in the Aetna network..

Step 3: Pay your share of the cost.

• When seeing any dentist, you’ll need to pay a portion of the cost.
• You’ll often pay less if you stay in the Aetna network. We agree on rates with providers in our network. But, we cannot control the amount an out-of-network provider may charge.
• The Retiree Dental Expense Plan has a modest deductible for in and out-of-network services.

Do you know what plan you want?