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This program is described in the chart below and similar to the POS II medical plan, as you may go to any provider for a covered procedure. However there is network of providers that offers a discount. A provider list can be obtained by using Aetna DocFind®. There is a deductible (separate from the medical deductible) for Type II, III and IV benefits.
Note: Your dental coverage is completely independent from your medical plan selection.
 Summary plan description 
Summary of coverages
Claim form
Aetna Resources for County Employees
Employees enrolled in the Traditional Dental plan are encouraged to visit the Aetna's website for specific claim information, health resources and provider information.
|
Type of benefit |
Procedures |
Plan payment percentage |
| I |
Preventative |
- cleaning, sealants (for dependents under age 19)
- fluoride treatments
- exams
- surgical removal of impacted teeth
- x-rays
- emergency pain treatment
|
- 100 percent of usual customary and reasonable allowance (UCR)
- no deductible
|
| II |
Routine restorative |
- Amalgram
- acrylic
- plastic fillings
|
|
| Oral surgery |
- single or multiple extractions
|
|
| Endodontics |
|
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| Periodontics |
- treatment of gums gingivectomy
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|
| III |
Repairs |
- adjustment or repairs to dentures and bridges
|
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| Major restorative |
|
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| Prothodontics |
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| IV |
Orthodontics |
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Maximum Benefit:
-
Type I, II, III: $1,500 per calendar year
-
Type IV: $1,500 lifetime benefit
Maximum Deductible:
- Per Person $50 per calendar year
- Per Family $150 per calendar year
- Per Family $150 per calendar year
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