BNY Mellon Benefits Guide
Aetna DMO
The Aetna DMO is a Dental Maintenance Organization. As with an HMO, you receive a benefit only when you use a participating provider. You must select a primary care dentist (PCD) who will provide most of your dental care and provide referrals, if needed. If you elect coverage for any eligible dependents, each dependent must also select a primary dentist (family members do not all have to select the same one). Here's how:
  • If you are enrolling in the Aetna DMO using the online system, go to the secure member website at www.aetna.com and click Log In/Register. You will be prompted to enter your DMO primary dentist's six-digit dental office number for each covered person. For information on the six-digit dental office number, click here or call 1-855-855-8112. No form is required.
  • When selecting a PCD, you must make your selection by the 15th of the month in order to use the provider as of the first of the following month.
  • When you go to the dentist, tell the office your name, date of birth and member ID number (available on the secure member website).
  • There are no deductibles or dollar maximums for covered services. Most diagnostic, preventive and basic services are covered in full at no out-of-pocket cost to you. There are some out-of-pocket costs associated with major services and orthodontic treatment as indicated in the table below. There is no annual or lifetime limit for orthodontics.
  • You will not receive a member ID card when you enroll in the Aetna DMO. However, you can print a card for you and your dependents by going to the secure member website at www.aetna.com.
  • If you elect Aetna DMO coverage, live in California or Arizona and do not select a primary care dentist, one may be selected for you. View your ID card online to determine if one was selected on your behalf.
  • If you are re-enrolling in the Aetna DMO and want to change your primary dentist, contact the plan directly. Dental plan phone numbers and website addresses can be found in the Contact Information section of this Guide.
AETNA DMO1
Annual Deductible
None
Choice of Any Provider
No
Plan Payments
Diagnostic and Preventive Services
  • Routine cleanings (2 per calendar year)
  • Routine exams (4 per calendar year)
  • Bitewing X-rays (2 sets per calendar year)
  • Full mouth X-rays (once every 3 years)
  • Emergency palliative treatment
  • Fluoride application (dependent children up to age 18; 1 per calendar year)
  • Sealants (1 every 3 rolling years on permanent molars only; no age limit)
  • Oral hygiene instruction
100% of PCD fee
Must use primary dentist or coordinated care
Basic Services
  • Amalgam (silver), anterior composite fillings
  • Root canal therapy – anterior and bicuspids
  • Apicoectomy
  • Simple extractions
  • Root planing and scaling
100% of PCD fee
Must use primary dentist or coordinated care
Major Services
  • Bridges
  • Inlays
  • Onlays
  • Root canal therapy – molars
  • Osseous surgery
  • Crowns
  • Crown lengthening
  • Dentures
  • Prosthetics
  • Full/Partial bony impactions
60% of PCD fee
Must use primary dentist or coordinated care
Orthodontia Services2
(Adults and children covered with no lifetime maximum; charges for orthodontic services are based on procedures performed; contact Aetna for details)
50% of the participating provider contracted amount
Annual Maximum
None
Lifetime Orthodontia Maximum
None
1 Aetna covers services only when your PCD coordinates your coverage; no coverage is available out of network.
2 Orthodontia is eligible on a monthly basis only. Charges for services not yet rendered are not allowed. Upfront reimbursement for the entire procedure is prohibited unless treatment is complete and braces have been removed. You must remain covered under this plan to receive continued reimbursement for orthodontic services.
Age, frequency limitations or exclusions may apply to certain services. For specific details, please contact Aetna directly.