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Serving Areas
All of Pennsylvania
Philadelphia
Pittsburgh
Allentown, Erie, Reading, Scranton, Bethlehem, Lancaster, Levittown, Altoona, Harrisburg, Penn Hills, Wilkes-Barrre, York, State College, Chester, Norristown, Radnor,Williamsport, Drexel Hill, Back Mountain
, Butler
Cranberry




Aetna Dental Access (only $6.95 a month)

This plan also include Vision and Prescription Drug Plan

Procedure Description Usual Fee   Member  Pay Member Savings
Routine 6 Month Check-Up $40 $22 $18
Full Mouth X-Rays $104 $53 $51
Four Bitewing X-Rays $49 $25 $24
Panoramic Film $87 $48 $39
Adult Teeth Cleaning $75 $39 $36
Child Teeth Cleaning $53 $31 $22
Protective Sealant / Tooth $41 $22 $19
1 Surface White Filling for U or L Front Tooth $110 $62 $48
Single Crown - Porcelain on High Noble Metal $867 $515 $352
Single Crown - Porcelain on Noble Metal $838 $495 $343
Root Canal Treatment - Molar $794 $480 $314
Period Scaling and Root Planning $208 $115 $93
Full Upper Denture $1,252 $675 $577

Fully Insured Dental From Aetna

call for Pricing (724)612-7458
Aetna PPO Plus Plan pays* Aetna PPO Plan pays*
Diagnostic and preventive 100% 80%
Periodontal maintenance cleanings 80% 50%
Denture repair, rebase and relining 80% 50%
Basic restorative (fillings) 50% 50%
Oral surgery 50% 50%
Endodontics (root canals) 50% 50%
Additional coverage
Periodontics 50% 50%
Crown and cast restorations 50% 50%
Prosthodontics (dentures) 50% 50%
Temporomandibular joint (TMJ) dysfunction Not covered Not covered
Deductibles and maximums per member enrolled
Deductible (calendar year) $50 $100
Maximum benefit (calendar year) $1,200 $1000
Waiting period
Basic 6 months 6 months
Major 18 months 18 months

Above list of covered services is representative.

*Out-of-network coverage is limited to a maximum of the plan’s payment, which is based on the negotiated, contract rate for in-network providers in a particular

Vision from ECI (Include with Aetna Dental Access)

PRODUCT / MEDICAL PROCEDURE

SUGGESTED RETAIL

YOUR COST

YOUR SAVINGS

% SAVINGS

Eye Exam

$ 50.00

Free *

$ 50.00

100%

Single-Vision, Polo Classic Frames with UV protection, tint and scratch resistant coating

$ 257.00

$ 133.00

$ 124.00

48%

Progressive, Guess Model 251 Frames with UV protection and scratch resistant coating

$ 419.00

$ 225.00

$ 194.00

46%

Disposable Contact Lenses (per box)

$ 24.75

$ 18.95

$ 5.80

23%

Revo Advanced Oval Sunglasses*

$ 275.00

$ 149.00

$ 126.00

45%

Serengeti Navigator (Model DR5403) Sunglasses *

$ 150.00

$ 85.00

$ 65.00

43%

LASIK Surgery *

$ 2,500.00

$ 2,000.00

$ 500.00

20%

Cataract Surgery *

$ 2,500.00

$ 800.00

$ 1,700.00

68%

CO2 Laser Skin Resurfacing**

$ 5,000.00

$ 4,000.00

$ 1,000.00

20%


*Not ALL providers offer FREE eye exams.
Please check your zip code/area for a complete list.

 

 

Our experience goes unmatched.
We have over 17 years and have solved thousands of problem solving cases that
independent brokers have brought to Medical Benefits Network for their customer help.

 

 

 

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