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Learn about these benefits
Dental, eyewear and hearing coverage are offered as a network benefit or as a direct member reimbursement (DMR) benefit. View your Evidence of Coverage (EOC) for coverage details that are specific to your plan.
Network benefits
Plans that offer benefits through a network may require you to see a network provider.* You may have a different network for medical benefits than for dental, eyewear or hearing services. Your EOC can help you find the right network for your plan.
*Some HMO-POS and PPO members can also see providers that are not part of the network for certain services. However, they may have higher costs.
Direct member reimbursement (DMR) benefits
Plans that offer benefits through a direct member reimbursement (DMR) provide you with an annual allowance. You can use this allowance toward the costs for covered services provided by a licensed provider of your choice. Members pay out of pocket at the time they get care. They then send us a receipt and reimbursement form to get reimbursed up to the plan’s allowance.
You'll pay out of pocket at the time you get care and we'll reimburse you afterwards. Just file a claim and include your receipt and any required information. You can then be reimbursed up to your plan's allowance.
Dental benefits
Plans that offer benefits through a network cover preventive care such as oral exams, cleanings and X-rays.* Some plans include comprehensive services such as fillings and extractions. You can find specific benefit information in the Evidence of Coverage.
Plans that offer DMR benefits cover most dental procedures, including preventive care and comprehensive services.
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Network |
DMR |
|
|---|---|---|
|
Who you can see for care |
Has a separate dental network to use** |
Allows you to see any dental provider*** |
|
How it works |
Network providers agree to bill us directly |
Member pays up front and submits information to get reimbursed |
|
Oral exams |
|
|
|
Routine cleanings |
|
|
|
X-rays |
|
|
|
Fillings |
Covered on some plans. See your EOC for details. |
|
|
Extractions |
Covered on some plans. See your EOC for details. |
|
|
Teeth whitening |
† |
† |
|
Network |
|
|---|---|
|
Who you can see for care |
Has a separate dental network to use** |
|
How it works |
Network providers agree to bill us directly |
|
Oral exams |
|
|
Routine cleanings |
|
|
X-rays |
|
|
Fillings |
Covered on some plans. See your EOC for details. |
|
Extractions |
Covered on some plans. See your EOC for details. |
|
Teeth whitening |
† |
|
DMR |
|
|---|---|
|
Who you can see for care |
Allows you to see any dental provider*** |
|
How it works |
Member pays up front and submits information to get reimbursed |
|
Oral exams |
|
|
Routine cleanings |
|
|
X-rays |
|
|
Fillings |
|
|
Extractions |
|
|
Teeth whitening |
† |
*Coverage for the frequency of these services may vary based on your plan.
**Some HMO-POS and PPO members can also see dentists that are not part of the network. Members of these plans that choose a provider not in the Aetna Dental® PPO Network may have higher costs. If a provider not in our network is not willing to bill us directly, members may have to pay upfront and submit a request for reimbursement.
***Must be a licensed provider in the U.S.
†Generally, cosmetic services (such as teeth whitening) are not covered.
Eyewear benefits
Plans that offer eyewear benefits through a network cover one annual routine vision exam. And an annual allowance that can be used to purchase prescription eyewear.
Plans that offer DMR benefits cover one annual routine vision exam and provide an annual allowance to purchase prescription eyewear.
|
Network |
DMR |
|
|---|---|---|
|
Who you can see for care |
Select a vision provider from a network** |
Any vision provider* |
|
How it works |
Network providers agree to bill us directly |
Member pays up front and submits information to get reimbursed*** |
|
Routine vision exam |
|
|
|
Eyewear coverage (glasses/contacts) |
|
|
|
Network |
|
|---|---|
|
Who you can see for care |
Select a vision provider from a network** |
|
How it works |
Network providers agree to bill us directly |
|
Routine vision exam |
|
|
Eyewear coverage (glasses/contacts) |
|
|
DMR |
|
|---|---|
|
Who you can see for care |
Any vision provider* |
|
How it works |
Member pays up front and submits information to get reimbursed*** |
|
Routine vision exam |
|
|
Eyewear coverage (glasses/contacts) |
|
*Must be a licensed provider in the U.S.
**Some PPO members can also see vision providers that are not part of the network but may have higher costs.
***Visit AetnaMedicareVision.com for a list of providers that don’t require you to take any action for eyewear reimbursement. If you use one of these providers, there’s no need to submit a claim form and receipt for eyewear reimbursement. The provider will automatically apply your eyewear benefit up to your plan’s annual eyewear coverage limit and submit the claim to us.
Hearing benefits
Most of our plans include coverage for hearing aids through a network provider. We teamed up with NationsHearing to provide hearing exam and hearing aid benefits. Hearing benefits generally include one annual routine hearing exam and hearing aid fitting covered at 100 percent. Most plans also include coverage toward the purchase of hearing aids.
|
Network |
|
|---|---|
|
Who you can see for care |
Any NationsHearing provider |
|
How it works |
Contact NationsHearing to schedule your appointment |
|
Routine hearing exam |
|
|
Hearing aid coverage |
|
|
Hearing aid fitting |
|
|
Network |
|
|---|---|
|
Who you can see for care |
Any NationsHearing provider |
|
How it works |
Contact NationsHearing to schedule your appointment |
|
Routine hearing exam |
|
|
Hearing aid coverage |
|
|
Hearing aid fitting |
|
Submitting your reimbursement
Submitting your reimbursement
If your plan has a DMR structure, we'll need the information below to process your reimbursement request for dental or eyewear. You may need to obtain some of these items during your visit, so be sure to capture all the information needed while you are there.
- A copy of the paid itemized receipt from the provider, including:
- The date of service
- The name of your provider
- The address of your provider
- A brief description of the service(s) or item(s) you are requesting reimbursement for (for example, tooth crown) and/or procedure codes
- Diagnosis codes
- Your first and last name
- Your member ID
- Your date of birth
Put your member ID on each item you send us, such as the receipt from the provider. Then send them to us along with your reimbursement claim.
