The 2025 Open Enrollment that began October 7, 2024 and ended on October 25, 2024 at 8pm (ET) is now closed.
Dental Coverage Options
All GW Postdoc Associates, Scholars and their eligible dependents can choose from three voluntary dental plan options powered through Aetna.
- Aetna Dental PPO (High)
- Aetna Dental PPO (Low)
- Aetna Dental DMO (Dental Maintenance Organization). You must choose a Primary care Dentist with this option.
- Note: If you are currently enrolled in the GW Staff Aetna DMO and do not wish to change your PCP, Aetna will keep your current PCD selection on file.
The GW dental plans are “stand-alone” plans, so you can enroll in dental coverage whether or not you have medical coverage through GW. Take a look at the tables on following pages to evaluate which of the options may be right for you.
| Aetna Dental PPO (High Option) | Aetna Dental PPO (Low Option) | |||
| Core Benefits | In-Network | Out-of-Network | In-Network | Out-of-Network |
| Annual Deductible (Individual) | $50 | $50 | $50 | $50 |
| Annual Deductible (Family) | $150 | $150 | $150 | $150 |
| Annual Maximum Coverage* | $1,500 | $1,500 | $1,000 | $1,000 |
| Preventive/Diagnostic** | ||||
| Oral Exam(s) | 100% | 100% | 100% | 100% |
| Cleaning (a) Adult/Child | 100% | 100% | 100% | 100% |
| Fluoride (a) | 100% | 100% | 100% | 100% |
| Sealants (permanent molars) (a) | 100% | 100% | 100% | 100% |
| Space Maintainers | 100% | 100% | 100% | 100% |
| Bitewing x-rays* | 100% | 100% | 100% | 100% |
| Full mouth series* | 100% | 100% | 100% | 100% |
| Basic Restorative** silver/composite fillings, root canals, stainless steel crowns, some extractions, some oral surgery, general anesthesia, osseous surgery (a) etc. | 90% | 80% | 80% | 70% |
| Major Restorative** crowns, dentures, implants, inlays, onlays, etc. | 50% | 50% | Not Covered | Not Covered |
| Orthodontics | ||||
| Child | 50% ($1,500 Lifetime Max) | 50% ($1,500 Lifetime Max) | Not Covered | Not Covered |
| Adult | 50% ($1,500 Lifetime Max) | 50% ($1,500 Lifetime Max) | Not Covered | Not Covered |
*Not all are covered as preventative and may incur a cost
**Services shown are a partial list. For a complete list , see your Dental Plan Benefit Summary , available at gwu.gpa.services
(a) Frequency and/or age limitations may apply to these services. These limits are described in the booklet/certificate
| DMO | |
| In-Network | |
| Core Benefits | Participant Pays |
| Annual Deductible | None |
| Annual Benefit Maximums | Unlimited |
| Preventive/Diagnostic | |
| Office Visit | $5 |
| Routine Exam | $0 |
| Teeth Cleanings (Prophylaxis) | $0 |
| Fluoride - Child | $0 |
| Sealants | Up to $10 Copay |
| Space Maintainers | Varies; Copay up to $80 |
| X-rays | $0 |
| Basic Procedures | |
| Amalgam Fillings (silver) | No Charge |
| Resin/Composite Fillings (white) | Varies; Copay up to $75 |
| Endodontics | Varies up to $400 Copay |
| Periodontics | Varies up to $375 Copay |
| Oral Surgery | Varies up to $120 Copay |
| Major Procedures | |
| Crowns | Varies up to $315 Copay |
| Dentures | Varies up to $1215 Copay |
| Implants | Varies up to $320 Copay |
| Orthodontia | |
| Child | $2300* |
| Adult | $2300* |
*Once complete comprehensive orthodontic treatment per lifetime (excludes dentition)
**Resin/composite (white) anterior teeth only)
Disclaimer: Certain services have specific restrictions. Contact Aetna member services for more details. (877-238-6200)
Aetna Dental Maintenance Organization (DMO)
The Aetna DMO 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 of your dental care. No out of network coverage provided.
If your PCD believes you need to visit a dental specialist, he or she will refer you to a specialist in the DMO network. 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.
Orthodontic services are available for both adults and children and require a $2,300 copay. Orthodontic services must begin while covered on the DMO plan and the participant must remain on the DMO plan throughout the duration of the orthodontic care to have full coverage.
Please note— You must elect a Primary Care Dentist (PCD) from within the Aetna network to coordinate all of your dental care.
To be effective on the first of the month, Primary Care Dentist (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 his/her monthly roster.
Accessing Out-of-Network Care Under a PPO Plan
When you seek services in-network, meaning, from providers listed in the PPO network, you pay less for care. When you pay 50% for major services from an in-network PPO dentist, you are paying 50% of a contracted, discounted rate. This is not the case with out-of-network providers.
Out-of-Network Example: The out-of-network dentist charges $1,000 for a porcelain crown on a molar. This dentist can charge whatever they want for this service. Your percentage of the cost for out-of-network care is 50% after the $50 deductible. For this service (a crown), the Usual, Customary and Reasonable (UCR) cost is $800, so you pay $425.
IN ADDITION, you owe the difference between the UCR amount and the dentist’s charge ($1,000—$800), which is an additional $200.
Total estimated cost out-of-network for the porcelain crown on a molar: $625
What is a Usual, Customary and Reasonable (UCR) Charge?
Usual, customary and reasonable charges are set by the insurance company, based on the prevailing cost of a service in your geographic area. The insurance company then determines how much it will pay for a given service in your area.
Enhanced Benefit
Each of the three dental plans cover an additional cleaning or visit to treat gum disease if you have heart disease, diabetes or are pregnant. If you have one of these conditions or are pregnant and would like to enroll in these enhanced benefits, please call the Aetna Dental Medical Integration Team at (800) 779-3357, Monday through Friday from 8 a.m. to 6 p.m. EST. A dental care coordinator will be happy to assist you.