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2017 Biweekly rates for zip code
|Aetna Dental PPO||Self Only||Self + 1||Self & Family|
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|Dental Plan details||Payment details|
|Yearly benefit maximum
|Class A (preventive) services
Like cleanings and X-rays
|Plan pays 100%*|
|Class B (minor) services
Like fillings and simple extractions
|Plan pays 60%*|
|Class C (major) services
Like crowns, root canals, dentures
|Plan pays 40%*|
|Class D (Orthodontia) services - Braces**
Lifetime maximum per member**
|Plan pays 50%*
**Covered after continuous enrollment in plan for 12 months.
Dental benefits are offered, underwritten and/or administered by Aetna Life Insurance Company (Aetna).
This material is for information purposes only. Not all dental services are covered. See FEDVIP brochure (PDF) for a complete description of benefits, exclusions, limitations and conditions of coverage. Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Information is believed to be accurate as of the production date; however, it is subject to change.