Health & Life Insurance
2023 Dental
Full-time (including RSP) and part-time employees can choose from three options through Aetna:
- Preventive Preferred Dental Organization (PPDO)
- Preferred Dental Organization (PDO)
- Dental Maintenance Organization (DMO)
This chart is a high-level summary of the features of all three options. For more detailed coverage information, please refer to the PNC Dental Benefits Summary Plan Description (SPD).
| Preventive Preferred Dental Organization (PPDO) | Preferred Dental Organization (PDO) | Dental Maintenance Organization (DMO) | |
|---|---|---|---|
| Network* | You may see any dentist but will save money if you use an in-network* PDO provider. If you use an out-of-network provider, you’re reimbursed based on a percentage of the recognized charge for services. If an out-of-network provider’s fees are greater than the recognized charge, you must pay the excess directly to the provider. | You may see any dentist but will save money if you use an in-network* PDO provider. If you use an out-of-network provider, you’re reimbursed based on a percentage of the recognized charge for services. If an out-of-network provider’s fees are greater than the recognized charge, you must pay the excess directly to the provider. | You must select a primary-care dentist from the Aetna DMO network* before you receive services. Only services received from or referred by your primary-care dentist are covered. |
| Primary-Care Dentist | There is no requirement to choose a primary-care dentist. | There is no requirement to choose a primary-care dentist. | You must choose a primary-care dentist**, selected from Aetna’s DMO network on Aetna’s website before you receive any dental services. Each covered family member may choose a different primary-care dentist. |
| Annual Deductible | If you cover yourself only: $25 If you cover any family members: $25 individual deductible, $50 family deductible |
If you cover yourself only; $50 If you cover any family members: $50 individual deductible, $150 family deductible |
None |
| Preventive Care (includes checkups and cleanings) | 100% covered, not subject to the deductible Includes two checkups and cleanings per person, per calendar year |
100% covered, not subject to the deductible Includes two checkups and cleanings per person, per calendar year |
100% covered Includes four checkups and two cleanings per person, per calendar year |
| Basic Services (may include fillings, non-preventive x-rays, prefabricated crowns, and root canals) |
80% covered after deductible Full and partial bony impactions, osseous surgery and molar root canals are not covered |
80% covered after deductible 50% covered after deductible for full and partial bony impactions, osseous surgery, and molar root canals |
100% covered 50% covered for full and partial bony impactions, osseous surgery, molar root canals and impacted wisdom teeth |
| Major Services (includes crowns, bridges, dentures) |
Not covered | 50% or 80% covered after deductible; varies by service | 50% covered |
| Annual Maximum Benefit | $1,000 per person | $2,000 per person | Unlimited |
| Other Services | |||
| X-ray |
Bitewing: 2 per calendar year Full mouth: 1 per 60 months 100% covered; not subject to the deductible |
Bitewing: 2 per calendar year Full mouth: 1 per 60 months 100% covered; not subject to the deductible |
Bitewing: 2 per calendar year Full mouth: 1 every 3 rolling years 100% covered |
| Sealants | Covered up to age 19, once per 5 rolling years; 100% covered; not subject to the deductible | Covered up to age 19, once per 5 rolling years; 100% covered; not subject to the deductible | Employees and dependents/ once per tooth every 3 rolling years, permanent molars only 100% covered |
| Topical fluoride treatment | Covered up to age 19 , 2 per year, 100% covered; not subject to the deductible | Covered up to age 19, 2 per year, 100% covered; not subject to the deductible | Limited to 1 treatment per calendar year; Covered up to age 18 100% covered |
| Scaling and root planing | 1 per 36 months, per quadrant 80% covered after deductible |
1 per 36 months, per quadrant 80% covered after deductible |
4 separate quads per 1 rolling year 100% covered |
| Composite fillings | Covered for all teeth (including molars) 80% covered after deductible | Covered for all teeth (including molars) 80% covered after deductible | 100% covered |
| Implants | Not covered | Covered
50% covered after deductible |
Not covered |
| Orthodontia | Not Covered |
Covered for adults and children 50% covered after deductible to lifetime maximum benefit of $1,500 per covered individual |
50% covered per eligible covered child through age 19. |
*To find in-network providers: If you are enrolled in the PPDO or PDO (and are also enrolled in PNC medical coverage) you can use Castlight to find in-network providers, provider quality information and personalized cost estimates. Or, visit aetna.com or call 877-238-6200 and specify PDO or DMO network. (The PDO and PPDO use the same network of participating providers.) Note: The Aetna website lists the PDO and PPDO as “Dental PPO/PDN with PPO ll and ExtendSM.” The DMO is listed as “DMO/DNO.”
**You must elect your primary-care dentist (PCD) with Aetna before you receive care through the DMO. If you enroll in dental coverage for the first time during annual enrollment, you can choose your PCD in mid- to late December, and you can change your PCD as often as once a month. Changes or new elections made by the 15th of the month will be effective the first day of the following month. If you make a change after the 15th, it will take an additional month for your election to take effect.
At the dentist: Tell your provider that you have employer coverage through Aetna. Participating providers will be able to confirm your coverage with Aetna; they may ask you for your Social Security number for identification purposes. After each visit, you’ll get an Explanation of Benefits (EOB) that shows the cost of services and what the plan paid. If you’re in the PDO or PPDO, it will also show your remaining deductible and annual benefit maximum. If you have questions about the EOB, contact Aetna at 877-238-6200.
For additional details: Please see the PNC Dental Benefits SPD.
