Dental Health Maintenance Organizations

 
 

Benefits Summary Plan Description

Dental Health Maintenance Organizations

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Dental Health Maintenance Organizations (DHMOs)

A DHMO is a network of dentists and specialists who provide dental care services at a fixed cost. With the DHMO, a participant does not have to meet a deductible or file any claim forms. The DHMO is available only in areas where there are participating dentists.

How the Plan Works

When a participant enrolls in a DHMO, he or she, as well as his or her dependents, must choose a primary care dentist. Each covered person may select his or her own primary care dentist. This primary care dentist will provide all routine dental care and will refer the participant to a network specialist whenever he or she needs specialty care.

For routine dental care — such as check-ups or fillings — a participant should make an appointment with his or her primary care dentist. When the participant goes in for the visit, he or she will pay the required copayment for covered services. The participant does not have to file a claim form after receiving care.

If a participant receives dental care without going through his or her primary care dentist first, or if the participant's care is not authorized by the plan, the DHMO will not pay any benefits. The participant will pay the full cost of any out-of-network or unauthorized care.

Choosing a Primary Care Dentist

The participant and each dependent must select a primary care dentist from the DHMO's network of providers.

Each participant can change his or her primary care dentist at any time during the year. To select or change a primary care dentist, a participant can call the Member Services number on the back of his or her ID card.

ID Cards

Participants enrolled in the Cigna DHMO plan will receive an ID card in the mail. This ID card contains important information about the participant, as well as about the benefits under the plan.

Participants enrolled in the Aetna DMO plan will not receive an ID card. However, Aetna will mail out a welcome letter that will contain the participant ID number and information regarding Aetna Navigator. The participant can register on the website and print out a paper ID card if they so choose.

What is Covered

The DHMOs generally cover preventive, basic and major services. The DHMOs also generally cover orthodontia services.

Refer to a DHMO's certificate of coverage for a complete list of what is covered by the plan.