Health & Life Insurance

Dental

Effective Jan. 1, 2018, you can choose from three options through Aetna:

  • Dental Maintenance Organization (DMO)
  • Preferred Dental Organization (PDO)
  • Preventive Preferred Dental Organization (PPDO)

This chart is a high-level summary of the features of all three options; 2018 changes are highlighted. For more detailed coverage information, please refer to the 2018 Dental Comparison Chart available on Pathfinder or to the PNC Dental Benefits Summary Document.

Preferred Dental Organization (PDO) Preventive Preferred Dental Organization (PPDO) — new option effective Jan. 1, 2018 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 dentist, you’re reimbursed based on a percentage of the reasonable and customary (R&C) charge for services. If an out-of-network provider’s fees are greater than R&C, 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 dentist, you’re reimbursed based on a percentage of the reasonable and customary (R&C) charge for services. If an out-of-network provider’s fees are greater than R&C, 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.
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. Only services received from or referred by your primary-care dentist are covered.
Annual Deductible $50 employee/$150 family $25 employee/$50 family None
Preventive Care (includes two checkups and cleanings per person in a calendar year) 100% covered and not subject to the deductible 100% covered and not subject to the deductible 100% covered
Basic Services (includes fillings, oral surgery and root canals)

80% covered after deductible

50% covered after deductible for full and partial bony impactions

80% covered after deductible

100% covered

50% covered for full and partial bony impactions

Major Services
(includes crowns, bridges, dentures)
50% covered after deductible Not covered 50% covered (includes molar root canals, osseous surgery and impacted wisdom teeth)
Annual Maximum Benefit $1,500 per person $750 per person Unlimited
Changes for 2018
Full mouth x-ray 1 per 60 months

100% covered after deductible
1 per 60 months

100% covered after deductible
No Change – 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
No change – 100% covered
Sealants Covered up to age 19, once per 60 months;

100% covered; not subject to the deductible
Covered up to age 19, once per 60 months;

100% covered; not subject to the deductible
No change – 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
No change – 100% covered
Composite fillings Covered for all teeth (including molars)

80% covered after deductible
Covered for all teeth (including molars)

80% covered after deductible
No change – 100% covered
Implants Covered

50% covered after deductible
Not covered No change – not covered
Orthodontia Covered for adults and children

50% covered after deductible to lifetime maximum benefit of $1,500 per covered individual
Not covered No change – 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. Note: The Aetna website lists the PDO and PPDO as “Dental PPO/PDN with PPO II Network.” (The PDO and PPDO use the same network of participating providers.)

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 Summary Document.

The part-time dental option remains the same for 2018.

Aetna Voluntary Dental Coverage
Annual Deductible $50 per person
Preventive Services Includes checkups and cleanings 80% of negotiated cost (in-network) or recognized charge (out-of-network) covered after deductible; no waiting period
Basic Services Includes fillings; oral surgery; denture, bridge and crown repair 60% of negotiated cost (in-network) or recognized charge (out-of-network) charge covered after deductible once enrolled in this coverage with no interruptions for three months
Major Services Includes periodontics and endodontics, crowns, bridges and dentures 50% of negotiated (in-network) or recognized (out-of-network) charge covered after deductible once enrolled in this coverage with no interruptions for 12 months
Annual Maximum Benefit $500 per person
Orthodontia Not covered

To find in-network providers: Visit aetna.com or call 888-772-9682.

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 have questions about the EOB, contact Aetna at 877-238-6200.

For additional details: Please see the PNC Part-Time Benefits Summary Document