Dental
Care Plan Comparison
Benefit Summaries
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... |
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 |
$1,500
for basic, major & preventive |
| 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 - Specialty Care Dentist Services
Aetna DMO Dental Plan - Pennsylvania Rider
|
