[Music, Voiceover] Welcome. Thanks for joining us to learn more about Aetna dental plans. If you're a current employee, a retiree, or a new employee with the state of New Jersey, you're in the right place.
Aetna®, along with the state health benefits program and the school employees health benefits program are offering two active member dental plans and two retiree dental plans. Even if you like the plan you're in, it's a good idea to review your plan selections every year. Aetna offers cost-effective, easy to understand nationwide dental programs for you to choose from.
Let’s take a look…
The Aetna Dental Expense Plan and Retiree Dental Expense Plan are offered to members by Aetna. These plans are great for members who like the freedom to go in and out of the Aetna network. With these plans, members can see any licensed dentist, no referral required. The Dental Plan Organization and Retiree Dental Plan Organization are great nationwide plans for members who like to budget their costs with a lower monthly premium compared to the Dental Expense Plan. These plans are in-network only dental plans and members select a primary care dentist when enrolling. Today, we will cover the benefits available to active employees under both the Aetna Dental Expense Plan and the Dental Plan Organization. Let's take a closer look at the plan details.
The Aetna Dental Expense Plan or DEP consists of our Preferred Provider Organization, also referred to as the PPO network of providers with both in- and out-of-network coverage. The plan allows members to choose any licensed dentist for dental care. However, out-of-network providers typically cost more, and services can be balanced billed. The benefits of the in-network Aetna Dental Expense Plan are an annual deductible of $50 for individuals and $100 for families, preventive services such as diagnostic and preventive care, covered at 100%, basic services such as routine fillings and extractions paid at 80%, major services such as crowns paid at 65%, an annual plan maximum of $3,000 for in-network services. And for out of network benefits, the following amounts apply: an annual deductible of $75 for individuals and $150 for families, preventive services such as diagnostic and preventive care covered at 90%, basic services such as routine fillings and extractions paid at 70%, major services such as crowns paid at 55%, an annual plan maximum of $2,000 for out-of-network services. The plan maximum combined for in- and out-of-network services is $3,000, excluding orthodontics.
Orthodontics are covered only for dependents who start treatment before age 19. In-network has a $1,000 lifetime maximum, and out-of-network has a $750 lifetime maximum. Remember to stay in-network whenever possible.
Now, let's move on to the second plan, the Dental Plan Organization or DPO, which uses Aetna's in-network Dental Maintenance Organization, also referred to as DMO. This plan requires members to select a primary care dentist and obtain referrals to see a dental specialist. The benefits of the Dental Plan Organization include no annual deductible, preventive services, such as diagnostic and preventive care covered at 100%, a copay for basic services, such as routine fillings and extractions, and major services such as crowns. Plus, there's no annual plan maximum. Copays will vary by type of service.
Dental Plan Organization orthodontics are covered for all members. For members under age 18, the lifetime maximum is $1,000 or 50% billed, whichever is less, For members over age 18, the lifetime maximum is $1,750 or 50% billed, whichever is less. In summary, this plan is more cost-effective. You'll pay less out-of-pocket for services, plus it carries a lower premium. Check to see if your provider participates in the Dental Plan Organization, and then be sure to choose a primary care dentist when you enroll.
The Aetna state of New Jersey website at AetnaStateNJ.com is the resource for Aetna dental plan options for state of New Jersey employees, their families, and retirees. To review Aetna dental plan options for current employees or retirees, select dental in the menu bar, then employee dental plans or retiree dental plans. You'll have access to detailed information on both plans by selecting the plus sign next to each plan name.
Not sure which plan is right for you? You can view the Dental Benefits at a Glance PDF, available for download. If you need to find a primary care dentist, please choose find a doctor in the top menu bar. This will open a new page where you can continue as a guest and enter your zip code. Under dental plans, select Dental Plan Organization for the in-network plans or Dental Expense Plan for the in- and out-of-network plans. Next, select dental care. Then dentists. A list of participating providers will be shown.
If you're selecting the Dental Plan Organization, you'll need to make a note of the primary care ID number on your dental application. As an Aetna member, you can also receive discounts and savings on certain benefits. To learn more, select tools and resources in the menu bar on AetnaStateNJ.com, then select discount programs to view available programs and their offerings.
Once you're a member, you can log in to the Aetna member website to view claims, print an ID card, and access all your benefits information. Thanks for sharing time with us to review Aetna dental plan options. For additional information, please visit the Aetna state of New Jersey website or call our customer service team at 1-877-StateNJ and see how Aetna can make you and your family smile. [Voiceover ends. Music fades out]
CCG STATENJ-0031 (9/21) ©2021 Aetna Inc.