The Retiree Dental Plan is administered by Aetna. It offers significant cost savings when you use providers in Aetna’s Dental PPO/PDN with PPO II network.
The following is an overview of the 2023 Retiree Dental Plan. For details, review the
summary plan description.
Plan Features
| |
Benefits |
|
Annual Deductible
|
$50 per individual/$150 per family
|
|
Benefit Maximums |
|
Annual maximum
Lifetime maximum
Lifetime orthodontic maximum
|
- $2,000 per covered individual per calendar year
- Unlimited, except for orthodontic
- $2,500 per covered dependent
under age 19
|
Covered Services
| |
What You Pay |
|
Preventive and Diagnostic Services
- Routine oral exams (2 per year)
- Cleaning and scaling of teeth (3 per year)
- Bitewing and diagnostic X-rays
- Fluoride application
(dependents under age 16)
- Sealants
- Space maintainers
- Problem-based exams
|
Covered 100%,
no deductible
|
|
Restorative Services
- Simple extractions
- Oral surgery for wisdom teeth extraction. Other oral surgery, if not covered by your medical plan
- Fillings, except gold
- Repair or re-cementing of crowns, inlays, bridgework, dentures
- Relining of dentures
- Treatment of diseases of the gums and tissues of the mouth (periodontics)
- Endodontic treatments such as root canals
- General anesthesia, if medically necessary
|
20% after deductible
|
|
Major Services
- Crowns, inlays or gold fillings
- Dentures
- Fixed bridgework (including inlays and crowns as abutments)
|
50% after deductible
|
|
Orthodontic Services
Braces and other orthodontic treatment for dependents under age 19
|
50%, no deductible
Up to lifetime benefit
of $2,500
|
Vital Savings by Aetna
Oxy offers Vital Savings by Aetna, an affordable alternative to the Retiree Oxy Dental Plan. This program offers discounts on dental care through the Aetna Dental Access Network.
Learn more »
You have three ways to join the program:
