Dental Plan Benefit Summary

Dental Care Plan
Benefit Summary

2009 Rates

Princeton University offers three (3) "employee pay all" dental plans to eligible faculty and staff. The dental programs are administered by Aetna and MetLife. You have the choice of selecting from one of the three dental plans: Aetna DMO Dental or MetLife Basic or High Option Dental Plans. Once you choose a plan you must remain in that plan until the next Open Enrollment period.

Please note not all treatments are covered. For example, some treatments labeled as preventative by dental professionals, including but not limited to full or partial- mouth debridement, are not covered under this Plan. We recommend that prior to receiving dental services you should contact Aetna or MetLife for verification of service coverage.

The chart below provides a brief overview of the benefits offered. Please review the Aetna Dental Plan package and the MetLife Dental Plan package for more details, or call the Office of Human Resources at 609-258-3302.

Plan Provision	MetLife Basic Option PPO Dental Plan Pays...	*Aetna DMO Plan Pays...**	MetLife High Option PPO Dental Plan Pays...
Plan Provision	MetLife Basic Option PPO Dental Plan Pays...	*Aetna DMO Plan Pays...**	In Network	Out of Network
Preventive/Diagnostic Services Examinations/Visits X-rays Prophylaxis, cleanings Fluoride Treatments	You may use in- or out-of-network providers; however, reimbursement is based on 100% of the in-network charge.	100% You may use In-network DMO providers only	100%	100%
Basic Services Amalgam (Silver) Fillings Root canal therapy, anterior teeth Composite fillings, anterior teeth only Stainless steel crowns Uncomplicated extractions	You may use in- or out-of-network providers; however, reimbursement is calculated based on 50% of the in-network charge.	100% You may use In-network DMO providers only	90%	70%
Major Services High Noble metal and Porcelain Inlays High Noble Metal Restorations Crowns Root canal therapy, molar teeth**	Out-of-network providers are not covered. You will receive up to a 30% discount off average charges from a participating provider.	60% You may use In-network DMO providers only Implants are not covered under the Aetna DMO Plan	60%	50%
Orthodontia	Out-of-network providers are not covered. You will receive up to a 30% discount off average charges from a participating provider. Covers children and adults.	50% No Lifetime maximum Covers children and adults	50% Lifetime maximum benefit of $2,000 Covers children and adults	50% Lifetime maximum benefit of $1,500 Covers children and adults
Annual Deductible	In-network: None Out-of-network: $50 single $150 family	None	$50 single/$150 family for basic & major services	$50 single/$150 family for basic & major services
Calendar Year Maximum	$2,000 for basic and preventive	None	$2,000 for basic, major & preventive services	$1,500 for basic, major & preventive services
Basis of Reimbursement	Maximum Allowable charge	Negotiated Fee	Negotiated Fee	80th percentile of reasonable and customary (R & C)

* Election of the Aetna DMO plan requires the completion of an additional vendor enrollment form. Please click here for a copy of the enrollment form.

** Included in the Basic Services category for MetLife Basic and High Option Dental Plan

AETNA DMO: The Aetna DMO offers a broad range of covered services and savings on dental expenses. There are no claim forms, no deductibles and no annual or lifetime maximums. Each covered member may select a different Primary Care Dentist from the Aetna DMO network of participating dentists. The plan covers preventative services at 100% of a negotiated fee, and major services at 60% of the negotiated fee. Adult and child orthodontia is also covered at 50% of negotiated fees. You must complete an enrollment form if you choose this option. Please click here for a copy of the enrollment form.

Aetna DMO Dental - Plan Design
Aetna DMO Dental Plan - Summary of Coverage - New Jersey
Aetna DMO Dental Plan - Summary of Coverage - Pennsylvania
Aetna DMO Dental Plan - New Jersey Rider - Primary Care Dentist Services
Aetna DMO Dental Plan - New Jersey Rider - Speciality Care Dentist Services
Aetna DMO Dental Plan - Pennsylvania Rider