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    Dental Insurance PPO  

    • $50 per individual per calendar year
    • $100 per family per calendar year

    Benefit Maximums
    • $1,500 Calendar year maximum benefit allowance per person for Types I, II, and III
    • $1,000 Lifetime maximum benefit allowance per child for Type IV

    Benefit Percentages (of reasonable and customary fees of covered expenses)
    • Type I: 100% Coverage of preventative maintenance visits to include cleanings, exams, and x-rays
    • *Type II: 80% Coverage of basic dental procedures to include fillings, routine extractions, root canals, periodontal cleanings, and gum surgeries
    • *Type III: 50% Coverage of major restorative procedures to include crowns, inlays, bridges, and dentures
    • *Type IV: 50% Coverage of orthodontic services for covered children only; employees and their spouses are not eligible for this benefit
    • You may use any dentist.
    • Aetna will pay based on reasonable and customary charges.

    * Individual or family deductible must be met before coverage percentages apply.

    * See Aetna website for Aetna providers