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2002 DoD NAF Passive Preferred Provider Organization (PPO)* Dental Plan Annual Deductible - Individual $100 Family maximum (family of 3 or more) $300 Calendar-Year Benefit Maximum $1,500 Lifetime Maximum Benefit for TMJ $750 (Temporomandibular Joint Dysfunction / Myofacial Pain Dysfunction) Preventive Care Oral Exams (two per calendar year), cleanings, X-rays, fluoride 100%, no deductible treatments to age 15, sealants to age 18 Basic Care Fillings, root canal therapy, extractions, general anesthesia, space 80% after deductible maintainers to age 19, palliative treatments Restorative Care 50% after deductible Inlays, crowns fixed bridgework, gold fillings Oral Surgery 100% of first $1,000; 80% thereafter not subject to the annual deductible or calendar-year benefit maximum Orthodontia 50%, no deductible Adults and children (not subject to the calendar-year benefit maximum) $1,500 lifetime orthodontia maximum per person Coordination of Benefits Method ”Maintenance of Benefits” method (see below) * New change for 2002 PASSIVE PPO DENTAL INFORMATION: You are NOT REQUIRED to visit a PPO Network dentist – this is a Passive PPO plan - visit any dentist you wish. You don’t even have to know whether or not your dentist is in a network. You CAN visit a network dentist for one procedure, a non- network dentist for another. For each visit, the plan coverage and your share, if any, will have the applicable base as described below. 1. If you visit a NON-NETWORK dentist: the plan coverage in the chart above will be based on the Reasonable & Customary (R&C) fee for the procedure. Your share, if any, would have the same base – R&C fee. 2. If you visit a NETWORK dentist: the plan coverage in the chart above will be based on the negotiated (network) fee for the procedure. Your share, if any, would have the same base – network fee. 3. Because negotiated (network) fees are lower than the R&C fee, visiting a NETWORK dentist will save you money (i.e., your share has a smaller base). 4. To find a NETWORK dentist: visit http://www.aetna.com/docfind/index.html, click Dentists, and “Dental PPO” in the drop- down menu, or call Aetna Member Services at 1-800-367-6276 for assistance. Aetna’s online version is updated three times a week. 5. Coordination of Benefits (COB) method - for medical and dental: Remember, the "coordination of benefits" (COB) method changed for DoD NAF HBP plans in 2000. Almost all group insurance plans have COB provisions. If a person has medical/dental coverage under two plans (AAFES and one other), COB explains how the two plans 'coordinate' for possible reimbursement. The new method since 2000 maintains the secondary plan's normal benefit. This change affected both the: Medical plans - Traditional Choice, and "out of network" claims in POS and PPO, and the Dental plan but participants may notice it most in the dental plan, for claims submitted on their dependents. Here’s a comparison of old method prior to 2000 ("100% Allowable") and new method 2000 and after ("Maintenance of Benefits"): 100% Allowable (Past method) Maintenance of Benefits (New method) A claim is submitted for $100.00. A claim is submitted for $100.00. Our plan's normal benefit = $85.00 Our plan's normal benefit = $85.00 The other (primary) carrier paid = $80.00 The other (primary) carrier paid $80.00 Total amount owed to provider = $100.00 Total amount owed to provider = $100.00 Our plan will pay $20.00 after COB. Our plan will pay $5.00 after COB.
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