2024 Open Enrollment Period: October 9 - 27, 2023
Dental Coverage Options
LTD recipients are eligible to choose from three voluntary dental plan options.
The GW dental plans are “stand-alone” plans, so you can enroll in dental coverage whether or not you have medical coverage through GW.
Reasonable and Customary: Dental providers who participate in the Aetna network have agreed to accept a standard level of payment for their services. This is called the “Negotiated” amount. Providers who are not in the network may charge more than the “Reasonable and Customary” amount, however, and your coverage will not pay more than that amount. You will be responsible for the difference.
Aetna Dental PPO Plans — High and Low Options
GW offers a choice of three voluntary dental plans through Aetna: High PPO, Low PPO and DMO. The Aetna Dental PPO plans is designed to provide you with a greater level of coverage for using service providers within the Aetna network. Some coverage is available for providers outside the Aetna network; however, any services you receive from an out-of-network provider will be paid only at the “Reasonable and Customary” amount.
The High Option provides you with a greater level of coverage, and therefore carries a higher premium. Adult orthondotia is covered under the High PPO Plan. The plan will pay 50%, up to $1500 towards adult orthodontia.
The Low Option provides you with preventive and basic coverage and has a lower premium. Take a look at the table below to evaluate which of the PPO options may be right for you.
Percentages in the accompanying chart represent the percentages of the negotiated amounts (in-network) and Reasonable and Customary amounts (out-of-network) covered by the plan.
| High Option Dental PPO | Low Option Dental PPO | |||
| In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Annual Deductible (Individual) |
$50 | $50 | $50 | $50 |
| Annual Deductible (per Family) |
$50 (max 3 per family) |
$50 (max 3 per family) |
$50 (max 3 per family) |
$50 (max 3 per family) |
| Annual Maximum Coverage* (per person per year combined in- and out-of-network) |
$1,500 | $1,500 | $1,000 | $1,000 |
|
Preventive Care** |
100% | 100% | 100% | 100% |
| Basic Care** silver/composite fillings, root canals, stainless steel crowns, some extractions, some oral surgery, general anesthesia, etc. |
90% | 80% | 80% | 70% |
|
Major Care** |
50% | 50% | Not Covered | Not Covered |
| Orthodontia (Adult and Children combined in- and out-of-network) |
50% |
50% (lifetime max $1,500) |
Not Covered | Not Covered |
* Under the Aetna High PPO or Aetna Low PPO plans, preventive care services do not apply toward your annual maximum.
** Services shown are a partial list. For a complete list, see your Dental Plan Benefits Summary, available at hr.gwu.edu/dental-benefits.
*** Implants are covered under the DMO and Aetna High PPO only.
Aetna Dental Maintenance Organization (DMO)
The Aetna DMO option provides benefits in a similar manner to an HMO medical plan. You must elect a Primary Care Dentist (PCD) from within the Aetna network to coordinate all your dental care.
To be effective on the first of the month, PCD selections must be received by Aetna by the 15th of the month prior. In order to schedule an appointment with your PCD, your name must appear on their monthly roster.
If your PCD believes you need to visit a dental specialist, they will refer you to a specialist in the DMO network.
The DMO Plan includes dental implant coverage. Read the DMO Plan Summary on the Benefits website for more information.
Orthodontic services are available for both adults and children and require a $2,300 copay. The DMO does not provide coverage outside of the Aetna network. There is no deductible to meet under the DMO, nor is there an annual maximum coverage amount. Office visits require a $5 copay.
More information is available at hr.gwu.edu/dental-benefits.