DENTAL PLANS
SUMMARY OF COVERAGE
Plan Features
DPPO Plan
DMO Plan
IN NETWORK Annual Deductible (Individual / Family) Preventive Care Basic Procedures (Fillings, etc.) Major Procedures (Crowns, etc.) Child Orthodontia
$50 / $150
NA / NA
100%
100% No charge
100%
100% No charge
60%
60% coinsurance
Not Covered
Not Covered
Calendar Year Maximum Benefit
$2,000
N/A
OUT OF NETWORK Annual Deductible (Individual / Family) Preventive Care Basic Procedures (Fillings, etc.) Major Procedures (Crowns, etc.) Child Orthodontia
$50 / $150
100%
80%
N/A
50%
Not Covered
Calendar Year Maximum Benefit
$2,000
Aetna’s Freedom of Choice Dental plan allows employees to switch from DMO to PPO or PPO to DMO as long as it is within certain time frames each month.
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DENTAL PLAN I
Callen Lorde BENEFITS GUIDE
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