Aetna Dental Maintenance Organization (DMO)

A DMO is a network of dentists and specialists who provide dental care services at a fixed cost. With the DMO, a participant does not have to meet a deductible or file any claim forms. The Aetna DMO is available only in areas where there are participating dentists.

How the Plan Works

Participants, including dependents, who enroll in a DMO plan, must choose a primary care dentist. Each covered person may select his or her own primary care dentist. This primary care dentist will provide all routine dental care and will refer the participant to a network specialist whenever specialty care is needed.

For routine dental care — such as check-ups or fillings — a participant should make an appointment with the primary care dentist. When visiting the dentist, the participant will pay the required copayment for covered services. The participant does not have to file a claim form after receiving care.

If a participant receives dental care without going through his or her primary care dentist first, or if the participant's care is not authorized by the plan, the Aetna DMO will not pay any benefits. The participant will pay the full cost of any out-of-network or unauthorized care.

Choosing a Primary Care Dentist

The participant and each dependent must select a primary care dentist from the Aetna DMO's network of providers.

Each participant can change his or her primary care dentist at any time during the year. To select or change a primary care dentist, a participant can the call Member Services number on the back of their ID card.

ID Cards

Participants enrolled in the Aetna DMO plan will not receive an ID card. However, Aetna will mail out a welcome letter that will contain the participant ID number and information regarding Aetna Navigator. The participant can register on the website and print out a paper ID card if they so choose.

What's Covered

The Aetna DMO generally covers preventive, basic and major services as well as orthodontia services. 

Refer to the Aetna DMO's Benefit Summary or Evidence of Coverage for a complete list of what is covered by the plan.

Out-of-Network Coverage

Out-of-network coverage is provided only for services shown in the list of eligible dental services included in the Aetna DMO Schedule of Benefits. The “Amount payable by Aetna” applies only to eligible dental services provided by out-of-network providers. The amounts shown are not copayments, they are the maximum amounts that we pay under your plan for the listed eligible dental service.

When you get eligible dental services:

• You pay your out-of-network deductible
• You are responsible for any amounts above the maximum

Participants who go to out-of-network providers may be responsible for filing their own claims for reimbursement. Check with your provider for information on their payment and claim filing policies.