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Benefit Summary Information

University of Hartford Group Number: 724328
Phone number: 1-877-238-6200
Aetna, Inc. Website: www.aetna.com

Aetna, Inc. Freedom of Choice Dental insurance offers the employee the option of electing to enroll in the Aetna Dental Maintenance Organization (DMO) or the passive Preferred Provider Organization (PPO) plan. Depending on which plan the employee elects, the level of coverage will differ.

DMO - Choosing to participate in the DMO plan requires the employee and the eligible dependents to choose a dentist within Aetna’s DMO network of providers. There is no annual deductible or annual benefit maximum. Preventative and basic services are covered at 100%, while major services are covered at 60%. Orthodontia benefits apply.

PPO - Choosing to participate in the passive PPO plan allows the employee and the eligible dependents to use any dentist and receive some level of coverage. If you choose a dentist in Aetna’s PPO network of providers, there is a $75 annual individual deductible and a $225 family deductible. After the annual deductible is met, preventative services are covered at 80%, while basic and major are covered at 50%. Orthodontia benefits do not apply and there is a $1,000 annual benefit maximum. If you choose a dentist outside of the PPO network, reasonable and customary charges will be considered before benefits are applied.

Please note: You can move from the DMO to the passive PPO plan at any time; however, the effective date for this change is determined by when you alert Aetna. If you alert Aetna by the 15th of the month, your coverage effective date in the new plan will be the 1st of the following month. ALL insured eligible dependents must participate in the same plan (DMO or Passive PPO plan) to receive benefit coverage.

For further details on covered services, please refer to the appropriate Summary of Benefits.

Other information:

Download Enrollment/Change Form

Questions regarding this policy should be directed to your designated HR Representative.

The University reserves the right to change providers, or plan documents, or plan provisions, as it deems necessary. This page is designed to summarize the University of Hartford’s Aetna Freedom of Choice Dental Insurance. It is not intended to be all inclusive. Where there are differences between the provisions of this website and more specific statements contained in University files (such as plan documents), those statements shall control.