Fact Sheet #37 October 2023 Page 2
Dental Plans — Active Employees
This fact sheet is a summary and not intended to provide all information.
Although every attempt at accuracy is made, it cannot be guaranteed.
• Basic Services such as llings and extractions
are paid at 80 percent (in-network) of the
PPO-contracted allowance and 70 percent (out-
of-network) of the reasonable and customary al-
lowance, after deductible;
• Major Restorative Services, such as crowns,
are paid at 65 percent (in-network) of the PPO-
contracted allowance and 55 percent (out-of-
network) of the reasonable and customary al-
lowance, after deductible;
• Prosthodontic Services for new or replacement
dentures are covered at 50 percent (in-network)
of the PPO-contracted allowance and 40 percent
(out-of-network) of the reasonable and custom-
ary allowance, after deductible. Repairs to exist-
ing dentures are covered at 80 percent (in-net-
work) of the PPO-contracted allowance and 70
percent (out-of-network) of the reasonable and
customary allowances, after deductible;
• Periodontics (treatment of gum disease) is
covered at 50 percent (in-network) of the
PPO-contracted allowance and 40 percent (out-
of-network) of the reasonable and customary al-
lowance, after deductible;
• Orthodontics are available after you have been
a full-time employee for 10 months (with no de-
ductible), but only for your children under the
age of 19. Orthodontic services are reimbursed
at 50 percent (in-network) of the PPO-contracted
allowance and 40 percent (out-of-network) of the
reasonable and customary allowance, and have
a separate $1,000 in-network and $750 out-of-
network individual lifetime reimbursement bene-
t maximum; and
• Benet Maximum per covered individual is
$3,000 annually in-network and $2,000 out-of-
network for a maximum of $3,000 combined in-
and out-of-network. This maximum applies to all
eligible services except orthodontic, which has a
separate $1,000/$750 individual lifetime benet
maximum.
With the exception of emergency care, if your Dental
Expense Plan treatment includes charges that are
expected to cost more than $300, it is strongly rec-
ommended that your dentist le for predetermination
of benets with Aetna. With advance approval you
will know what services are covered and what pay-
ments will be made.
When you use an in-network dental provider, you
only pay the provider any applicable deductible and
the appropriate coinsurance based on the discount-
ed fee, thereby reducing your out-of-pocket cost. In
many cases the in-network dental provider will submit
the claims directly to Aetna, eliminating the necessity
to le claim forms. To nd an in-network provider, call
Aetna at 1-877-STATENJ (1-877-782-8365).
PREMIUM COSTS
For employees of the State, the premium cost for
dental plan coverage is shared between the State
and the employee. The amount of your payroll de-
duction is available from your human resources rep-
resentative or benets administrator. Dental rates
are also posted on our website.
State employee premiums can be paid on a pre-tax
basis through participation in the Premium Option
Plan (POP) of Tax$ave, a benet program available
under Section 125 of the federal Internal Revenue
Code (IRC). Participation in the POP is automatic
unless you le a form declining participation. The
Internal Revenue Service (IRS) strictly regulates en-
rollment in the POP and prohibits any benet chang-
es outside of an Open Enrollment period or unless a
qualifying life event occurs (e.g., loss of other cov-
erage, marriage, divorce, etc.). The Tax$ave Fact
Sheet explains the POP in more detail.
For employees of a participating local employer,
the premium cost for dental plan coverage will vary
based upon the policies of that employer, with regard
to health benet costs and any labor agreements
between the employer and the unions representing
the employee. Employees of a participating local em-
ployer should see their human resources represen-
tative or benets administrator for more information.
CHOOSING A DENTAL PLAN
Your choice of a dental plan is a personal decision. In
deciding whether to enroll and which plan to choose,
you should consider:
• The nature and amount of your anticipated den-
tal expenses for the next year;
• The covered services provided by the Dental Ex-
pense Plan or a DPO;
• The dierences in out-of-pocket costs for each
type of plan; and
• The degree of exibility that you may want in se-
lecting a dentist.
You can use the “Dental Plan Comparison” chart lat-
er in this fact sheet to compare benet levels under
each type of dental plan. If you choose a DPO, you
must select a dentist who participates with that par-
ticular DPO and who can accept you and your de-
pendents as patients.
The “Dental Plan Comparison” chart provides a
summary description of a variety of dental services
under the two types of dental plans oered by the
Employee Dental Plans. The chart is not complete
and does not describe all the benets, limitations,
or conditions associated with coverage under either
type of plan. Please refer to the Employee Dental
Plans Member Guidebook for additional details.