Dental & Vision

Our Aetna dental plans help you maintain a healthy smile through regular preventive dental care and offer coverage to fix problems early.

DHMO Plan

This plan covers in-network services only. If you visit an out-of-network provider, you’ll be responsible for the full cost of care. You will also need to select a primary dentist, who will coordinate your dental needs and provide referrals to specialists when necessary.

DPPO Plan

You can visit any dentist you choose, but you’ll receive the highest coverage when you stay in-network. Out-of-network visits don’t include discounted rates, so you’ll pay more for care. For some services, you may also need to meet an annual deductible.

Dental Plan Comparison

What’s Included in Your Coverage	DHMO Plan* (In-Network Only)	DPPO Plan** (In-Network)
Calendar Year Benefit Maximum	N/A	$1,500
Orthodontia Lifetime Maximum	N/A	$1,000
Amount you pay
Calendar Year Deductible Individual / Family	N/A	$50 / $150
Diagnostic & Preventive Services	$0	$0
Basic & Restorative Services	Copay varies by service	20%***
Major Services	Copay varies by service	50%***
Orthodontia Lifetime Maximum (adults and children)	$2,000	50%***

*For California residents only.
**For out-of-network services, members pay applicable coinsurance plus any amount that exceeds the usual, customary, and reasonable charge.
**After deductible.

Cost for Coverage

Your per pay period payroll deductions for dental are shown here.

Benefit Plan	Teammate Only	Teammate + Spouse	Teammate + Child(ren)	Teammate + Family
DHMO	$5.32	$10.63	$13.93	$20.42
DPPO	$13.98	$27.96	$37.29	$50.11

Vision

Our Aetna vision plan offers an extensive network of optometrists and vision care specialists. Remember, you’ll save money by visiting Aetna’s in-network providers.

What’s Included in Your Coverage	Aetna Vision Plan
	In-Network
	Amount You Pay
Exam every 12 months	$10
Frames every 12 months	Amount above $200 allowance, with 20% off balance
Lenses every 12 months	$10
Contact Lenses every 12 months (instead of lenses and frames)
Medically Necessary	$0
Elective	Amount above $200 allowance, with 15% off balance

*Out-of-network benefits available. See plan document for details.