2002 by suchenfz

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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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