Once enrolled, you and your eligible dependents must remain in the dental plan you elect for a minimum of 12-months before you can switch plans or drop coverage. In addition, no employee or dependent can be covered under more than one dental plan.
NOTE: Duplicate coverage within the dental plans is not permitted; an individual can be covered as an employee or as a dependent, but not both. Dependent children may only be covered by one parent.
You have a choice between two types of dental plans:
- The Dental Expense Plan; or
- A Dental Plan Organization (DPO)
DENTAL EXPENSE PLAN
The Dental Expense Plan is a traditional indemnity-type plan administered by Aetna Dental. The plan allows you to choose any licensed dentist for your dental care. There is a deductible to satisfy for some services and some services are eligible only up to a limited amount. The annual plan deductible is $50.00 per person; $150.00 per family. The deductible does not apply to diagnostic, preventive, and orthodontic services. After you satisfy the annual deductible, you are reimbursed a percentage of the reasonable and customary charges for services that are covered under the plan.
The Dental Expense Plan provides the following benefits:
Diagnostic and Preventive services are paid at 100% of reasonable and customary allowances with no deductible.
Basic Services such as fillings and extractions are paid at 80% of reasonable and customary allowances after paying the deductible.
Major Restorative services, such as crowns, are paid at 65% of reasonable and customary allowances after paying the deductible.
Prosthodontic services for new or replacement dentures are covered at 50% of reasonable and customary allowances after paying the deductible. Repairs to existing dentures are covered at 80% of reasonable and customary allowances after paying the deductible.
Periodontics (treatment of gum disease) is covered at 50% of reasonable and customary allowances after paying the deductible.
Orthodontics are available after you have been employed for 10-months (with no deductible), but only for your children under the age of 19. Orthodontic services are reimbursed at 50% of reasonable and customary allowances and have a separate $1,000 individual lifetime reimbursement benefit maximum.
Benefit Maximum per covered individual is $3,000.00 annually. This maximum applies to all eligible services except orthodontic, which has a separate $1,000.00 individual lifetime benefit maximum.
With the exception of emergency care, if your Dental Expense Plan treatment includes charges that are expected to cost more than $300.00, it is recommended that your dentist file for predetermination of benefits with Aetna.
Dental Expense Plan members can take advantage of a special Aetna network of participating dental providers. In this network, participating dental providers contract with Aetna for a discounted fee schedule. When you use a participating dental provider, you only pay the provider any applicable deductible and the appropriate coinsurance based on the discounted fee, thereby reducing your out-of-pocket costs. In many cases the participating dental provider will submit the claims directly to Aetna, eliminating the necessity of your filing claims forms. To find out if your dental provider participates in the discounted network, call Aetna at 1-877-238-6200.
DENTAL PLAN ORGANIZATIONS
The Dental Plan Organizations (DPOs) are companies that contract with a network of providers. You must use the dental provider participating with the DPO you select to receive coverage. Be sure you confirm that the dentist or dental facility you choose is taking new patients and participates with the NJ State Dental DPO plans.
When you use a DPO dentist, diagnostic and preventive services are covered in full. Most other eligible expenses require a copayment. In addition, orthodontic treatment is covered for both children and adults, subject to a copayment. If your dentist drops out of the DPO, you must select another dentist from the same DPO plan. If there are none available within 30 miles of your home, or if you move and your DPO cannot provide a dentists within 30 miles of your home, you can switch plans.
WHICH PLAN IS BEST FOR ME?
Your choice of a dental plan is a personal decision. In deciding whether to enroll and which plan to choose, you should consider the nature and amount of your anticipated dental expenses for the next year; the covered services provided by the plans; the out-of-pocket costs, and the degree of flexibility that you want in selecting a dentist.
Dental Carrier Contact Information:
Dental Expense Plan (Aetna).................877-238-6200
Atlantic Southern (Benecare) DPO.........800-843-4727
Community Dental DPO........................856-451-8844
Cigna Dental Health DPO......................800-367-1037
International (Healthplex) DPO...............800-458-0600
Horizon Dental Choice DPO..................800-433-6825
Aetna DMO DPO.................................800-843-3661
Group Dental Program Member Handbook: www.state.nj.us/treasury/pensions/dentalbook04.htm
Dental Fact Sheet: www.state.nj.us/treasury/pensions/fact37.htm
Click here to view Dental Rates.