1199SEIU Aetna DMO Dental Plan

The 1199SEIU Aetna DMO Dental Maintenance Organization (DMO) plan provides comprehensive dental care for you and your family – with no annual maximum dollar amount – covering all basic and preventive services 100 percent. A primary care dentist coordinates all of your care.

If you would like to sign up for the 1199SEIU Aetna (DMO) plan, your spouse and all of your eligible dependents who receive coverage through the Benefit Fund must also enroll in the plan. You may do so during a special open enrollment period in the fall for coverage that begins January 1. If you choose this option, you and your family must remain enrolled for at least one year, and each family member must choose a primary care dentist.

More About Your Aetna DMO Dental Benefits

View a Summary of Your Dental Benefits

Who Is Eligible?

Family Coverage — Wage Class I

Member-only Coverage — Wage Class III

Wage Class II is not covered

Not sure what wage class you are?

Check the front of your Health Benefits ID Card, or click here for an explanation.

Additional Resources

The 1199SEIU Aetna DMO Plan May be Right for You Because:

  • More than 5,000 participating dentists in New Jersey
  • No annual dollar maximum, including on orthodontia
  • Primary Care Dentist (PCD) to coordinate care and refer you to in-network specialists
  • Appointment app to schedule appointments
  • Dedicated 1199SEIU customer service, Monday to Friday, 8 am to 6 pm

Things You Should Know Before You Decide to Enroll in the Aetna DMO Plan:

  • Molar and certain premolar fillings are amalgam (metal) and not composite resin (tooth-colored), except in cases where the dentist does not have amalgam available
  • Crowns and bridges for molars (posterior teeth) are metal material
  • Referrals to specialists are required
  • No out-of-network coverage, except in an emergency

Benefit Overview1

ANNUAL MAXIMUM

NO $ ANNUAL MAXIMUM
NETWORK
  • Downstate NY: 2,442 PCD and Specialists
  • Upstate NY: 1,186 PCD and Specialists
  • NJ: 5,215 PCD and Specialists
  • Pennsylvania: 7,279 PCD and Specialists
  • Connecticut:  220 PCD and Specialists
OUT OF NETWORK

Primary Care Dentist coordinates all care. Referrals are required for in-network specialists. No out-of-network benefits except in emergencies.

Benefits/Services: 100% Covered, No Out-of-Pocket Costs for Covered Services

PREVENTATIVE SERVICES
  • 4 visits of all types of exams per calendar year
  • Prophylaxes (Cleanings) — 2 per Calendar Year
  • X-rays – One full set or panoramic (combined) every three rolling years. Radiographs performed by specialists (Periodontist, Endodontist, Orthodontist, and Oral Surgeons) are not subject to or counted towards frequency limitations. Bitewing x-rays limited to 1 set per calendar year.
  • Fluoride Treatments — 1 treatment per calendar year for covered children under age 16
  • Space Maintainers — for primary teeth only, No age or frequency limits
  • Occlusal Guards for Bruxism — 1 every 3 years with no age limit
  • Sealants — Once every three rolling years on permanent molars only for covered children under age 16
BASIC SERVICES
  • Fillings — Composite/resin is covered for all teeth in offices that do not offer amalgam (metal) fillings. In offices that do offer amalgam fillings, all molar composite/resin fillings and certain pre-molars composite/resin fillings are considered upgraded materials and subject to balance billing.
  • Root Canals for anterior teeth and bicuspids
  • Pulpotomies — on primary teeth only
  • Scaling — every 2 rolling years
  • Oral Surgery (Simple extractions, surgical extractions of erupted teeth)
  • Palliative Services (Relief of pain)
MAJOR SERVICES
  • Removable dentures are covered once every 5 years
  • Crowns and bridges are covered once every 5 years per tooth and are metal material for molars (posterior teeth).
  • Molar root canals
  • Oral Surgery — removal of impacted teeth
  • General Anesthesia and IV Sedation — Covered when in conjunction with eligible surgical procedures or when require by state regulations
  • Implants – Covered when prior authorized
  • Repair of Crowns, Bridges and Dentures
ORTHODONTICS Comprehensive treatment of dentition only

No $ Maximum 1 treatment per lifetime

Covered 100% No Out-of-Pocket Costs, covered when services begin prior to age 20 until completion.

  • Insertion
  • Retention Visits
  • Retainers

1Aetna DMO Plan has been approved for a 2-year pilot period. Continuation is contingent on enrollment mix and Aetna community rating.

If there is a discrepancy between the benefits in this document and the plan document, the benefits in the plan document will prevail.