Dental Plan – Aetna Dental Access ®

Sample Dental Savings

Select Regional Average Cost*

Discounted Fee

(for Plan Members)***

Member Savings

Adult Cleaning $82 $52 $30
Child Cleaning $49 $37 $12
Routine 6 Month Check-Up $39 $27 $12
Four Bitewing X-Rays $51 $31 $20
Composite (White) Filling $131 $76 $55
Crown – Porcelain Fused to Noble Metal $843 $584 $259
Complete Upper Denture $940 $763 $177
Molar Root Canal $826 $581 $245
Extraction (single tooth) $119 $70 $49

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Dental benefit is not available to VT residents.

*Actual costs and savings vary by service and geographical area.

** According to the Aetna Enterprise Provider Database as of November 1, 2010.

The discount program provides access to the Aetna Dental Access® network. This network is administered by Aetna Life Insurance Company (ALIC). Neither ALIC nor any of its affiliates offers or administers the discount program. Neither ALIC nor any of its affiliates is an affiliate, agent, representative or employee of discount program. Dental providers are independent contractors and not employees or agents of ALIC or its affiliates. ALIC does not provide dental care or treatment and is not responsible for outcomes.

*** If you are looking for a specific dental procedure that is not on this sample, please contact our 1020RX Member Services Center toll-free at 1-800-7-1020RX with the specific ADA Code of the procedure and we can assist with providing the discounted fee information.

The Aetna Dental Access ® program provides applicants access to a network of independent practicing providers. All network providers are independent contractors in private practice and are neither employees nor agents of Aetna Life Insurance Company and/or its parents, subsidiaries or affiliates (“Aetna”). The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. Aetna does not provide medical or dental care/treatment and is not responsible for outcomes. All dental care is the responsibility of the treating provider, in consultation with the applicant. Selection of a dentist is also the responsibility of the applicant and is not based on any representations by Aetna Dental Access®

THE AETNA DENTAL ACCESS® PROGRAM IS NOT AN INSURANCE PLAN. There are no benefits payable to those registering, nor does Aetna Dental Access® compensate dentists for services they may render to applicants. Aetna Dental Access® is not an insurer, guarantor or underwriter of any services provided under the program or of any payments to providers. Applicants arrange for needed dental care, including payment, directly with the network provider. Applicants are responsible for the entire cost of the dental care and Aetna Dental Access® shall in no event be liable for any payment to a provider accessed under the program or for the refusal of a provider to accept the discounted rates.

Aetna Dental AccessSM is a service mark of Aetna Inc.  The Aetna Dental Access SM program is offered by Aetna Life Insurance Company.