Small Business Solutions

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Small Business Solutions

Dental Benefi ts and Insurance Plan Options

14.02.926.1-FL B (1/08)

Florida

Dental benefi ts plans and dental insurance plans are offered, underwritten or administered by Aetna Life Insurance Company (Aetna).

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A healthy body starts with a healthy smile

When it comes to overall health, oral health is vitally important. There is

compelling research indicating a strong correlation between chronic, long-term

health problems, such as diabetes, heart disease and pregnancy complications,

with the presence of oral disease and infection.* That means the dentist can

literally be the catalyst in the prevention, early detection and treatment of

these diseases.

Periodontal disease

Periodontal disease is caused

by bacteria in the mouth and

includes gingivitis and periodontitis.

It impacts the gums and can

ultimately lead to tooth loss.

Without regular visits to and

proper treatment by the dentist,

periodontal disease can go

undetected and can lead to illnesses

with serious, long-term health

implications and a lifetime of

signifi cant medical costs. However,

the good news is that periodontal

disease is easily diagnosed and

treated through routine dental care.

Dental benefi ts can go a long way

in protecting overall health. Aetna

offers dental benefi ts along with

medical coverage in order to help

combat diseases from multiple

angles. Our goal is to offer a diverse

portfolio of dental products to

meet the needs of small business

employers and employees.

The Dental Maintenance Organization (DMO®_{) plan}

Offered as a coinsurance and fi xed copay

plan with two different coverage levels,

depending upon the plan option you choose.

Members select a primary care dentist to

coordinate their care. Each family member

may choose a different primary care dentist

and may switch dentists at any time via Aetna

Navigator

®

_{or with a call to Member Services.}

If specialty care is needed, a member’s

primary care dentist may refer the member to

a participating specialist. However, members

may visit orthodontists without a referral.

There are virtually no claim forms to fi le,

and benefi ts are not subject to deductibles or

annual maximums.

PPO plan

Members have the choice of using a dentist

who participates in Aetna’s network or

choosing a licensed dentist who is not in the

network. Participating dentists have agreed

to offer members services at a negotiated rate

and will not balance bill members.

PPO Max plan

The PPO Max plan uses the same PPO

network. When members use out-of-network

dentists, however, the service will be covered

based on the PPO fee schedule in that

geographic area, rather than the

reasonable-and-customary charge. This means that

the member will share in more of the costs

and will be balance billed. This plan design

enables your customer to offer members

a quality plan with a signifi cantly lower

premium that encourages in-network usage.

Freedom-of-Choice plan design

Get maximum fl exibility with our two-in-one

dental plan design. The Freedom-of-Choice

plan design gives you the administrative

ease of one plan and members get to choose

between the DMO and PPO plans on a

monthly basis. You pay one blended rate.

Members may switch between dentists at any

time via Aetna Navigator or with a call to

Member Services. Plan changes must be made

by the 15th of the month to be effective the

following month.

Dual Option plan design

In the Dual Option plan design the

DMO must be packaged with any one

of the PPO plans. Employees may choose

between the DMO and PPO offerings at

annual enrollment.

Voluntary Dental option

The Voluntary Dental option provides a

solution to meet the individual needs of

members in the face of rising health care

costs. No matter what the budget is,

employers can now afford to offer

their employees the luxury of choice.

Administration is easy and members benefi t

from low group rates and the convenience

of payroll deductions. With the Voluntary

Dental option, employers choose how the

plan is funded. It can be entirely member paid

or employers can contribute up to 50 percent.

This option is available January 1, 2007.

* The American Academy of Periodontology. The mouth body connection. Available at

www.surgeongeneral.gov/topics/oralhealth/nationalcalltoaction.htm. Accessed May 26, 2004.

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Aetna Dental/Medical Integration

SM

_program

The Mouth Matters

SM

More than 164 million work hours are

lost each year due to dental diseases and

visits.

1

_{Research also shows that more}

than 90 percent of all medical illnesses

are detectable in the mouth and that

75 percent of people over the age of

35 have periodontal (gum) disease.

2

Untreated oral diseases can have a

big impact on the quality of life. This

means that a dentist may be the fi rst

health care provider to diagnose a

health problem!

Aetna is proud to offer our Dental/

Medical Integration program at no

additional charge to plan sponsors that

have both medical and dental coverages

with Aetna. Our DMI program focuses

on those who are pregnant or have

diabetes, coronary artery disease (heart

disease) or cerebrovascular disease

(stroke) and have not had a recent

dental visit. Using a variety of outreach

methods, we educate those at-risk

members about the impact oral health

care can have on their condition. Our

member outreach has been proven

to successfully motivate those at-risk

members who do not normally seek

dental care, to visit the dentist. Once

at the dentist, these at-risk members

will receive enhanced dental benefi ts

including an extra cleaning and full

coverage for certain periodontal services.

1

Call your account representative

for more details!

1 _{U.S. Department of Health and Human Services, National Center for Chronic Disease Prevention} and Health Promotion; Resource Library Fact Sheet “Oral Health for Adults,” December 2006. 2 _{The professional entity, Academy of General Dentistry, 2007.}

DMI may not be available in all states.

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Available with an Aetna Medical Plan to Groups with 2 – 50 Eligible Employees

Available without an Aetna Medical Plan (Dental Standalone) to Groups with 5 – 50 Eligible Employees

MEMBER BENEFITS

Offi ce Visit Copay

Annual Deductible per Member (does not apply to Diagnostic & Preventive Services) Annual Maximum Benefi t

DIAGNOSTIC SERVICES

Oral Exams

Periodic oral exam Comprehensive oral exam Problem-focused oral exam

X-rays Bitewing — single fi lm Complete series PREVENTIVE SERVICES Adult cleaning Child cleaning Sealants — per tooth

Fluoride application — with cleaning Space maintainers

BASIC SERVICES

Amalgam fi lling — 2 surfaces permanent Resin fi lling — 2 surfaces, anterior

Oral Surgery

Extraction — Exposed root or erupted tooth Extraction of impacted tooth — soft tissue

MAJOR SERVICES*

Complete upper denture Partial upper denture

Crown — Porcelain with noble metal Pontic — Porcelain with noble metal Inlay — Metallic (3 or more surfaces)

Oral Surgery

Removal of impacted tooth — partially bony

Endodontic Services

Bicuspid root canal therapy Molar root canal therapy

Periodontic Services

Scaling & root planing — per quadrant Osseous surgery — per quadrant

ORTHODONTIC SERVICES*

Orthodontic Lifetime Maximum

A E T N A S M A L L G R O U P D E N T A L P L A N S

Plan Option 1 Plan Option 2

DMO Freedom-of-Choice — Monthly selection between the DMO and the PPO Max

DMO Plan DMO Plan PPO Max Plan Copay Plan 64 Copay Plan 64 100/70/40 $5 $5 N/A None None $50; 3x Family Maximum Unlimited Unlimited $1,000 No Charge No Charge 100% No Charge No Charge 100% No Charge No Charge 100% No Charge No Charge 100% No Charge No Charge 100% No Charge No Charge 100% No Charge No Charge 100% No Charge No Charge 100% No Charge No Charge 100% $75 $75 100% $12 $12 70% $21 $21 70% $11 $11 70% $46 $46 70% $275 $275 40% $275 $275 40% $255 $255 40% $255 $255 40% $195 $195 40% $58 $58 40% $109 $109 40% $280 $280 40% $51 $51 40% $300 $300 40% $2,300 Copay $2,300 Copay Not Covered Does Not Apply Does Not Apply Does Not Apply

Plan Option 3

Freedom-of-Choice — Monthly selection between the DMO and the PPO

DMO Plan PPO Plan 100/90/60 100/70/40 $5 N/A None $50; 3x Family Maximum Unlimited $1,000 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 90% 70% 90% 70% 90% 70% 90% 70% 60% 40% 60% 40% 60% 40% 60% 40% 60% 40% 60% 40% 90% 40% 60% 40% 90% 40% 60% 40% $2,300 Copay Not Covered Does Not Apply Does Not Apply

* Coverage Waiting Period: Must be an enrolled member of the Plan for 12 months before becoming eligible for coverage of any Major Service including Orthodontic Services. Does not apply to the DMO in Plan Options 1, 2 & 3. There is no Waiting Period for any covered service on the DMO.

All dollar amounts listed on the DMO plans are member’s responsibility. Access to negotiated discounts: On the PPO plans in Plan Options 2-6, members are eligible to receive non-covered services at the PPO negotiated rate when visiting a participating PPO dentist at any time, including during the Coverage Waiting Period.

Most Oral Surgery, Endodontic and Periodontic services are covered as Basic Services on the DMO in Options 1, 2 & 3 and on the PPO in Option 6.Plan Options 2 & 4: PPO Non-Preferred (Out-of-Network) Coverage is limited to a maximum of the Plan’s payment, which is based on the contracted maximum fee for participating providers in the particular geographic area.

Plan Option 1 DMO cannot be sold standalone as full-replacement coverage. It must be combined with any one of the PPO plans in Plan Options 4, 5 or 6 in a Dual Option offering.

Options 1 & 2: DMO Copay Plan 64 amounts listed are the total patient responsibility for the services indicated. The $5 Offi ce Visit Copay is additional.

Orthodontic coverage is available only to groups with 10 or more eligibles and for dependent children only in Plan Options 1, 2, 3 & 5; adults and dependent children in Plan Option 6.

Above list of covered services is representative. Full list with limitations as determined by Aetna appears on the plan booklet/certifi cate. For a summary list of Limitations and Exclusions, refer to the back page. 2

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Available without an Aetna Medical Plan (Dental Standalone) to Groups with 5 – 50 Eligible Employees A E T N A S M A L L G R O U P D E N T A L P L A N S

Plan Option 4

PPO Max

PPO Max Plan 100/80/50 N/A $50; 3x Family Maximum $1,500 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 80% 80% 80% 80% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% Not Covered Does Not Apply

All dollar amounts listed on the DMO plans are member’s responsibility. Access to negotiated discounts: On the PPO plans in Plan Options 2-6, members are eligible to receive non-covered services at the PPO negotiated rate when visiting a participating PPO dentist at any time, including during the Coverage Waiting Period.

Most Oral Surgery, Endodontic and Periodontic services are covered as Basic Services on the DMO in Options 1, 2 & 3 and on the PPO in Option 6. Plan Options 2 & 4: PPO Non-Preferred (Out-of-Network) Coverage is limited to a maximum of the Plan’s payment, which is based on the contracted maximum fee for participating providers in the particular geographic area.

Plan Option 1 DMO cannot be sold standalone as full-replacement coverage. It must be combined with any one of the PPO plans in Plan Options 4, 5 or 6 in a Dual Option offering.

Options 1 & 2: DMO Copay Plan 64 amounts listed are the total patient responsibility for the services indicated. The $5 Offi ce Visit Copay is additional.

Orthodontic coverage is available only to groups with 10 or more eligibles and for dependent children only in Plan Options 1, 2, 3 & 5; adults and dependent children in Plan Option 6.

Above list of covered services is representative. Full list with limitations as determined by Aetna appears on the plan booklet/certifi cate. For a summary list of Limitations and Exclusions, refer to the back page.

MEMBER BENEFITS

Offi ce Visit Copay

Annual Deductible per Member (does not apply to Diagnostic & Preventive Services) Annual Maximum Benefi t

Oral Exams Periodic oral exam Comprehensive oral exam Problem-focused oral exam X-rays Bitewing — single fi lm Complete series PREVENTIVE SERVICES Adult cleaning Child cleaning Sealants — per tooth

BASIC SERVICES

Amalgam fi lling — 2 surfaces permanent Resin fi lling — 2 surfaces, anterior Oral Surgery

MAJOR SERVICES*

Complete upper denture Partial upper denture

Crown — Porcelain with noble metal Pontic — Porcelain with noble metal Inlay — Metallic (3 or more surfaces) Oral Surgery

Removal of impacted tooth — partially bony Endodontic Services

Bicuspid root canal therapy Molar root canal therapy Periodontic Services

3

Plan Option 5

Active PPO Plan

Preferred Plan Non-Preferred Plan 100/80/50 80/60/40

N/A N/A

$50; 3x $50; 3x

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Access to negotiated discounts: On the PPO plans in Plan Options 2-4, members are eligible to receive non-covered services at the PPO negotiated rate when visiting a participating PPO dentist at any time, including during the Coverage Waiting Period.

Most Oral Surgery, Endodontic and Periodontic services are covered as Basic Services on the DMO in Options 1, 2 & 3.

Plan Options 2 & 4: PPO Non-Preferred (Out-of-Network) Coverage is limited to a maximum of the Plan’s payment, which is based on the contracted maximum fee for participating providers in the particular geographic area.

Plan Option 1 DMO cannot be sold standalone as full-replacement coverage. It must be combined with the PPO plan, Option 4 in a Dual Option offering.

Options 1 & 2 DMO Copay Plan 64 amounts listed are the total patient responsibility for the services indicated. The $10 Offi ce Visit Copay is additional.

Orthodontic coverage is available only to groups with 10 or more eligibles and for Dependent Children Only in Plan Options 1, 2, & 3. If there is a lapse in coverage, members may not re-enroll in the plan for a period of two years from the date of termination. If they are eligible for coverage at that time, they may re-enroll, subject to all provisions of the plan, including, but not limited to, the Coverage Waiting Period.

Above list of covered services is representative. Full list with limitations as determined by Aetna appears on the plan booklet/certifi cate. For a summary list of Limitations and Exclusions, refer to the back page. A E T N A S M A L L G R O U P V O L U N T A R Y P L A N O P T I O N S

Available without Medical Plan (Dental Standalone) to Groups with 10 – 50 Eligible Employees

$10 $10 N/A $10 N/A N/A

None None $75; 3x Family None $75; 3x Family $75; 3x Family

Maximum Maximum Maximum

Unlimited Unlimited $1,000 Unlimited $1,000 $1,500

No Charge No Charge 100% 100% 100% 100% No Charge No Charge 100% 100% 100% 100% No Charge No Charge 100% 100% 100% 100% No Charge No Charge 100% 100% 100% 100% No Charge No Charge 100% 100% 100% 100% No Charge No Charge 100% 100% 100% 100% No Charge No Charge 100% 100% 100% 100% No Charge No Charge 100% 100% 100% 100% No Charge No Charge 100% 100% 100% 100% $75 $75 100% 100% 100% 100% $12 $12 70% 90% 70% 80% $21 $21 70% 90% 70% 80% $11 $11 70% 90% 70% 80% $46 $46 70% 90% 70% 80% $275 $275 40% 60% 40% 50% $275 $275 40% 60% 40% 50% $255 $255 40% 60% 40% 50% $255 $255 40% 60% 40% 50% $195 $195 40% 60% 40% 50% $58 $58 40% 60% 40% 50% $109 $109 40% 90% 40% 50% $280 $280 40% 60% 40% 50% $51 $51 40% 90% 40% 50% $300 $300 40% 60% 40% 50% $2400 Copay $2400 Copay Not Covered $2400 Copay Not Covered Not Covered Does Not Apply Does Not Apply Does Not Apply Does Not Apply Does Not Apply Does Not Apply

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MEMBER BENEFITS

Offi ce Visit Copay

Annual Deductible per Member (does not apply to Diagnostic & Preventive Services)

Annual Maximum Benefi t

Oral Exams

BASIC SERVICES

Amalgam fi lling — 2 surfaces permanent Resin fi lling — 2 surfaces, anterior

Oral Surgery

MAJOR SERVICES*

Complete upper denture Partial upper denture (resin base) Crown — Porcelain with noble metal Pontic — Porcelain with noble metal Inlay — Metallic (3 or more surfaces)

Oral Surgery

Endodontic Services

Voluntary Option 1

DMO

DMO Plan DMO Plan PPO Max Plan DMO Plan PPO Plan PPO Max Plan Copay Plan 64 Copay Plan 64 100/70/40 100/90/60 100/70/40 100/80/50

Voluntary Option 2

Freedom of Choice — Monthly selection between DMO and PPO Max

Voluntary Option 3

Freedom of Choice — Monthly selection between DMO and PPO

Voluntary Option 4

PPO Max

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5 * Coverage Waiting Period: Must be an enrolled member of the Plan

for 12 months before becoming eligible for coverage of any Major Service including Orthodontic Services.

Access to negotiated discounts: On all PPO Max plans, members are eligible to receive non-covered services at the PPO negotiated rate when visiting a participating PPO dentist at any time, including during the Coverage Waiting Period.

PPO Max Non-Preferred (Out-of-Network) Coverage is limited to a maximum of the Plan’s payment, which is based on the contracted maximum fee for participating providers in the particular geographic area.

Orthodontic coverage is available only to groups with 10 or more eligibles and for dependent children only.

Voluntary Out-of-State Dental Plans – If there is a lapse in coverage, members may not re-enroll in the plan for a period of two years from the date of termination. If they are eligible for coverage at that time, they may re-enroll, subject to all provisions of the plan, including, but not limited to, the Coverage Waiting Period.

Above list of covered services is representative. Full list with limitations as determined by Aetna appears on the plan booklet/certifi cate. For a summary list of Limitations and Exclusions, refer to the back page. For out-of-state employees in all states except: Arkansas, Alaska, Hawaii, Idaho, Maine, Massachusetts, Montana, North Carolina, North Dakota, New Hampshire, New Mexico, South Dakota, Vermont, Wyoming.

A E T N A S M A L L G R O U P O U T - O F - S T A T E D E N T A L P L A N S

Available without Medical Plan (Dental Standalone) to Groups with 5 – 50 Eligible Employees

N/A N/A N/A N/A N/A N/A

$50; 3x Family $50; 3x Family $50; 3x Family $50; 3x Family $50; 3x Family $50; 3x Family Maximum Maximum Maximum Maximum Maximum Maximum $1,000 $1,000 $1,500 $1,500 $2,000 $2,000 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% 50% Not Covered 50% Not Covered 50% Not Covered 50% Does Not Apply $1,000 Does Not Apply $1,000 Does Not Apply $1,000

MEMBER BENEFITS

Offi ce Visit Copay

Annual Deductible per Member (does not apply to Diagnostic & Preventive Services)

Annual Maximum Benefi t

Oral Exams

BASIC SERVICES

Amalgam fi lling — 2 surfaces Resin fi lling — 2 surfaces, anterior

Oral Surgery

MAJOR SERVICES*

Complete upper denture Partial upper denture (resin base) Crown — Porcelain with noble metal Pontic — Porcelain with noble metal Inlay — Metallic (3 or more surfaces)

Oral Surgery

Endodontic Services

Low and Voluntary Option No Ortho Low and Voluntary Option Ortho Medium Option No Ortho Medium Option Ortho High Option No Ortho High Option Ortho

PPO Max Plan PPO Max Plan PPO Max Plan PPO Max Plan PPO Max Plan PPO Max Plan 100/80/50 100/80/50 100/80/50 100/80/50 100/80/50 100/80/50

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Listed below are some of the

charges and services for which

these dental plans do not provide

coverage. For a complete list of

exclusions and limitations, refer

to the plan documents.

■

Dental services or supplies that are

primarily used to alter, improve or

enhance appearance.

■

Experimental services, supplies

or procedures.

■

Treatment of any jaw joint disorder,

such as temporomandibular joint

disorder.

■

Replacement of lost, missing

or stolen appliances and certain

damaged appliances.

■

Those services that Aetna defi nes

as not necessary for the diagnosis, care

or treatment of a condition involved.

Specifi c service limitations

■

DMO plans: Oral exams (4 per year)

■

PPO plans: Oral exams (2 routine and

2 problem-focused per year)

■

All plans:

> Bitewing X-rays (1 set per year)

> Complete series X-rays

(1 set every 3 years)

> Cleanings (2 per year)

> Fluoride (1 per year; children

under 16)

> Sealants (1 treatment per tooth,

every 3 years on permanent molars;

children under 16)

> Scaling & root planing

(4 quadrants every 2 years)

> Osseous surgery

(1 per quadrant every 3 years)

■

All other limitations and exclusions

in the plan documents

Simple Steps To Better

Dental Health

®

_website

This site for dental health

information is an important Internet resource. It features a Parents’ Guide for information on oral health for babies and children; information on more than 55 dental conditions and treatments; an Ask the Dentist feature; information on orthodontics, periodontics, oral surgery and other dental specialties; and more.

Learn More

To learn more about

integrating medical and

dental benefi ts, contact

your broker or Southeast

Region Small Group

Sales at 1-888-422-2128.

This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Rates and benefi ts vary by location.

Plan features and availability may vary by location and group size.

Not all dental services are covered. See plan documents for a complete description of benefi ts, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change.

Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com.