About Dental

Eligibility and Enrollment

Dental PPO

Covered Expenses

Exclusions

Payments

Claims

Continuation Coverage

Administrative and ERISA Information

Key Terms

Benefit Summary

Index

A
Administrator-Benefits, 37-42
adoption, 10, 11
Aetna (and Aetna U.S. Healthcare), 1, 15, 16, 25, 26, 27, 28, 29, 31, 38-40, 43
dental PPO, 1, 4, 15-16, 26, 28, 38
Member Services, 1, 16, 26, 38, 39, 43
alternative course of treatment, 26
annual deductible, 20, 24, 25, 26, 51
family, 51
individual, 51
B
benefit plan service, 13, 44
Benefits Administration, 1, 8, 9, 10, 11, 12, 14, 33, 34, 35, 43
birth, 6, 10, 11
C
claims, 4, 14, 15, 24, 25, 28-31
administrator, 1
denial and reconsideration, 29
filing, 15, 28, 38-40
medical for dental work, 18, 31
outside the U.S., 29
cleanings, 19, 50, 51
COBRA, 4, 11, 13, 32-35
continuation of coverage, 32-35
coordination of benefits, 29-30
for a child, 29-30
for retirees, 29-30
co-payments, 24, 25, 26
cosmetic services, 21
coverage, 5-16, 25, 27, 29, 30, 32-35
changes, 10-14
adding a new family member, 10-11
leave of absence, 11
legal separation or divorce, 11
losing and regaining eligibility, 6
losing other dental coverage, 6
transfer, 11
classes of, 7
covered expenses, 4, 17-20

56

D
deductible, 4, 12, 19, 20, 21, 23-28, 28, 51
family, 51
individual, 51
definitions, 44-48
dental PPO, 1, 4, 15-16, 23, 28, 38
dentures and bridges, 17, 19, 21, 22, 26, 49, 51
dependents, 4, 5-14, 16, 19, 23, 28, 31, 45, 46, 51
divorce, 11, 30, 33, 34,35
E
eligibility, 5-14, 28, 46, 47
emergency treatment, 18
endodontics , 17, 51
enrollment, 5-12
special enrollment periods, 6
ERISA (Employee Retirement Income Security Act of 1974), 4, 35, 37-42
excluded expenses, 4, 21-22
extended part-time employee, 5, 13, 47
F
fillings, 19, 51
fluoride, 18, 51
G
general services, 19, 51
H
HR Intranet, 2, 8, 9
I
injections, 19
L
leaves of absence, 11
M
major services, 19, 24, 51
marriage, 6, 10
maximum benefits, 4, 12, 19, 20, 23, 24
calendar year, 23
orthodontic, 24
medically necessary, 17, 26, 44
N
network, 3, 4, 15-16, 22, 25, 28, 29, 51
finding a dentist, 16
non-network, 4, 15, 25, 28, 51
O
oral surgery, 19, 51
orthodontic services, 4, 17, 19
orthodontic maximum benefits, 24
P
participant rights, 41
plan numbers, 38
plan year, 38
pre-determination of benefits, 16, 47
pre-existing treatment, 9
preferred provider organization (PPO), 1, 3, 4, 15-16, 17, 25, 26, 27, 38
preventive services, 3, 17, 18, 51
Q
Qualified Medical Child Support Order, 13, 14

57

R
reasonable and customary, 17, 18, 24, 25, 26, 44, 51
regular employee, 14
retiree, 2, 5, 7, 9, 13, 14, 30, 34, 45
covered by two plans, 29
suspended, 6, 14, 29, 45
right of reimbursement, 23-26
root canals, 17, 19, 49, 50
S
sealants, 19
separation, 11, 51
space maintainers, 18, 50, 51
special enrollment periods, 6
survivors, 2, 5, 6, 7, 33, 48
suspended retiree, 6, 14, 48
T
transfers, 11
type of plan, 38
X
x-rays, 16, 18, 49, 51

                                         NOTES

59

                                         NOTES