Health & Life Insurance

Dental

Effective Jan. 1, 2019, full-time 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 and use 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 when you enroll and 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 (includes fillings, oral surgery 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% covered after deductible 50% covered
Annual Maximum Benefit $750 per person $1,500 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

100% covered: 1 every 3 rolling years
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, 3 per 24 months, 100% covered; not subject to the deductible Covered up to age 19, 3 per 24 months, 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
100% covered after deductible
1 per 36 months, per quadrant
100% 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: 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 II Network.” The DMO is listed as “DMO/DNO.”

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.