Aetna Vital Savings℠

Individual plan

Family plan*

Plus plan

Upgrade for $13.50/year

Save 10% $159.95

$143.96/year $12.00/month | billed annually

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Dental Savings Plan

Aetna Vital Savings℠

Aetna Vital Savings^SM provides participants with average discounts of 15-50% on dental procedures at more than 285,583** available dental practice locations nationwide through one of the largest dental savings networks – Aetna Dental Access^SM. It’s so easy to use – you’ll have your entire family smiling!

Save 15-50%

Save on dental implants, crowns, root canals, dentures and more.

Orthodontics savings

Save on child and adult braces, and related care.

Cosmetic savings

Save on teeth whitening, veneers/overlays and other smile enhancing care.

No annual limits

No spending caps that limit your annual dental care savings.

No restrictions

Yes, you can save on care for current dental conditions.

Vision and LASIK savings

Save 15-40% on exams, lenses, frames, LASIK and more.

Hearing

Save up to 60% on hearing devices and receive 2 years of free batteries.

Virtual dental care through Dental.com

Using SmartScan™ technology, and access to oral health products.

View Savings Details

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Upgrade your plan to save on prescriptions.

Additional Benefits

Prescription

+$13.50/year +$15.00/year

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Savings for the whole family.

Members under the family plan include all members of your immediate family currently living in your household.

+ $40.50/year

Upgrade to Family Plan

Details on savings and in-network dentists in your area.

Procedure description	Code	Without this plan¹	With this plan²	Sample savings percentage
Routine 6 month check-up	D0120	$55	$24	56%
Adult teeth cleaning	D1110	$99	$48	52%
Child teeth cleaning	D1120	$71	$34	52%
Single crown – porcelain on high noble metal	D2750	$1,225	$690	44%
Root canal treatment – front tooth	D3310	$922	$371	60%
Full upper denture	D5110	$1,887	$857	55%
Full lower denture	D5120	$1,850	$857	54%
Single tooth removal – simple extraction	D7140	$186	$70	62%
Extraction – impacted wisdom tooth (soft tissue)	D7220	$441	$158	64%

The sample table above is a small selection of common procedures discounted by Aetna Vital Savings^SM. The procedures discounted under Aetna Vital Savings^SM offer similar savings to the sample above.

¹The [“Price Without Plan”] is determined by DentalPlans.com, Inc., using benchmark data from FAIR Health, Inc. FAIR Health data is used under license. Fees may reflect combined fees from several different procedures into one procedure and may not be directly comparable to a specific benchmark in FAIR Health Data. Actual fees charged by your provider may vary for a variety of reasons.

²Discounted fees are listed for visits to a participating general dentist. Any procedure not listed on the complete fee schedule will be discounted 20% off the provider’s normal fee. Members will be charged the provider’s Aetna Vital Savings^SM contracted fees. Charges may vary from the sample fee schedule above. Consult with your provider prior to beginning any treatment.

This plan is based geographically by ZIP code in terms of provider participation and location. Fee schedules and savings may vary by ZIP code and by Provider within a ZIP code.

Procedure description	Code	Without this plan¹	With this plan²	Sample savings percentage
Routine 6 month check-up	D0120	$55	$24	56%
In depth check-up	D0150	$88	$34	61%
Full mouth x-rays	D0210	$146	$61	58%
Four bitewing x-rays	D0274	$66	$32	52%
Panoramic film	D0330	$147	$50	66%
Adult teeth cleaning	D1110	$99	$48	52%
Child teeth cleaning	D1120	$71	$34	52%
Protective sealant / tooth	D1351	$61	$28	54%
Perio scaling and root planing (per quadrant)	D4341	$299	$134	55%
Regular cleaning following periodontic procedure	D4910	$159	$63	60%

Procedure description	Code	Without this plan¹	With this plan²	Sample savings percentage
1 surface silver filling for primary or permanent tooth	D2140	$135	$59	56%
1 surface white filling for u or l front tooth	D2330	$169	$76	55%
Single crown – porcelain on high noble metal	D2750	$1,225	$690	44%
Single crown – porcelain on noble metal	D2752	$1,145	$670	41%
Core build-up with pins	D2950	$301	$130	57%
Root canal treatment – front tooth	D3310	$922	$371	60%
Root canal treatment – bicuspid	D3320	$1,095	$455	58%
Root canal treatment – molar	D3330	$1,327	$658	50%
Bone replacement graft – retained natural tooth – first site in quadrant	D4263	$484	$352	27%

Procedure description	Code	Without this plan¹	With this plan²	Sample savings percentage
Labial veneer (resin laminate) – direct	D2960	$675	$173	74%
Labial veneer (porcelain laminate) – indirect	D2962	$1,275	$499	61%
External bleaching – per tooth	D9973	$185	$23	88%
Internal bleaching – per tooth	D9974	$350	$112	68%

Procedure description	Code	Without this plan¹	With this plan²	Sample savings percentage
Full upper denture	D5110	$1,887	$857	55%
Full lower denture	D5120	$1,850	$857	54%
Add clasp to existing partial denture	D5660	$305	$167	45%
Surgical placement of implant body: endosteal implant	D6010	$2,436	$1,487	39%
Abutment supported cast metal crown (predominantly base metal)	D6063	$1,439	$665	54%
Implant supported crown high noble alloys	D6067	$1,621	$732	55%
Tooth replacement part of permanent bridge	D6210	$1,139	$655	42%

Procedure description	Code	Without this plan¹	With this plan²	Sample savings percentage
Single tooth removal – simple extraction	D7140	$186	$70	62%
Extraction – impacted wisdom tooth (soft tissue)	D7220	$441	$158	64%
Extraction – impacted wisdom tooth (partial bony)	D7230	$587	$172	71%

Procedure description	Code	Without this plan¹	With this plan²	Sample savings percentage
Comprehensive orthodontic treatment of the transitional dentition	D8070	$5,562	$3,155	43%
Full orthodontic child treatment (braces)	D8080	$5,658	$3,419	40%
Full orthodontic adult treatment (braces)	D8090	$5,936	$3,594	39%

Type of Dentist	Member Savings
ENDODONTICS	Call
ORAL SURGERY	Call
ORTHODONTICS	Call
PEDODONTICS	Call
PERIODONTICS	Call
PROSTHODONTICS	Call

This fee schedule is only to be used as a guide to determine approximate prices for dental services in the geographic area noted. The discounted fee schedule amount reflects the average fee information currently available on our systems. Individual dentist fee schedules may differ. Aetna Vital Savings^SM makes no guarantee as to the accuracy of any particular fee amount. In order to determine the specific rates for a dental provider, you should contact the dental provider directly.

¹ The [“Price Without Plan”] is determined by DentalPlans.com, Inc., using benchmark data from FAIR Health, Inc. FAIR Health data is used under license. Fees may reflect combined fees from several different procedures into one procedure and may not be directly comparable to a specific benchmark in FAIR Health Data. Actual fees charged by your provider may vary for a variety of reasons

²Discounted Fees / Price With Plan Fees are listed for visits to a participating general dentist. Members will be charged the provider’s Aetna Dental Access^SM contracted fees. Charges may vary from the sample fee schedule above. Consult with your provider prior to beginning any treatment. Lab fees may be additional.

This plan is based geographically by ZIP code in terms of provider participation and location. Fee schedules and savings may vary by ZIP code and by Provider within a ZIP code.

Included in your Aetna Vital Savings^SM is a vision savings plan by Aetna Vision powered by EyeMed. Aetna Vision provides a simple way to reduce eye care costs by taking advantage of savings.

Receive access to savings on the following benefits:

Aetna Vision – eye exams, lenses, frames and more

The Aetna Vision network gives you access to 65,000+ eye care professionals nationwide.

This includes major retailers such as:
Vision Source, Pearle Vision Centers, Target Optical, Visionworks, and more.

Vision Care Savings at a Glance

Save 20-40% off the retail price of eye exams, eye glasses and contact lenses
Save 35% off the retail price of frames
Save $15 off the retail price of contact lens exam
Save 15% off the cost of Lasik surgery
Save on brand names in eyewear such as Anne Klein, bebe®, Calvin Klein and more
Replacement contact lenses by mail – Order replacement contact lenses via the Internet and have them mailed directly home
Unlimited Use on materials throughout the year

Sample Savings

Description	Cost Without Aetna Vision²	Cost with Aetna Vision¹	Discount Savings¹	Typical Savings
Eye Exam	$90	$63	30%	$27
Designer Frames³	$190	$123.50	40%	$66.50
Contact Lens Exam	$120	$105	12%	$10
Lenses – Single Vision	$270	$189	30%	$81

Notes:

Actual pricing and discounts may vary by region and eye care provider
Sample pricing from LensCrafters
Frame Pricing based on Tory Burch Women’s Frames & Dolce & Gabanna Men’s Frames at LensCrafters

To locate providers, click here

Included in your Aetna Vital Savings^SM Plus membership is a hearing benefit through Amplifon, which will provide you access to savings regarding your hearing care needs including exams, hearing aids, and other hearing care services.

Receive access to savings on the following benefits:

Amplifon – access to one of largest hearing providers in the country with savings on a variety of hearing aids and services and more.

The Amplifon hearing program provides savings on hearing exams and services at more than 4,600 locations nationwide, and offers deep discounts on hearing aid brands such as: Oticon, Phonak, ReSound, Rexton, Starkey, Miracle-Ear, Sonic, Siemens, Unitron, and more.

This program provides instant savings on diagnostic services, including hearing exams, services and select hearing health products.

Hearing Savings at a Glance

Save up to 60% on hearing devices
FREE Initial Screening*
Save up to 25% on diagnostic testing
Save 20% on audiologist select hearing health products
2 years of FREE batteries with hearing aid purchase mailed directly to your home
1 year of follow-up care which includes cleaning, adjustment and other hearing aid services
3-year warranty on most hearing aids, covering repairs, loss and damage
60-day no-risk trial period. If you are not satisfied, return your hearing aids within the trial period for a 100% refund
Hearing Aid Low Price Guarantee – if you should find the same product at a lower price, bring us the local quote, and we’ll not only match it – we’ll beat it by 5%!

*Depending upon provider. Some providers may charge a $48 fee

Sample Hearing Savings

Description	Cost without Plan	Cost with Plan	Discount	Typical Savings
Siemens Hearing Aid Premier	$3,400	$1,900	44%	$1,500
Siemens Hearing Aid Economy	$1,595	$695	56%	$900
¹*Cost per year

Virtual dental care through Dental.com

Using SmartScan™ technology, we can spot cavities, gum disease, plaque, and other issues. Right from the comfort of home. You also get exclusive access to oral health products specially recommended for your dental needs.

* Actual costs and savings may vary by provider, service and geographic location.
** According to the Aetna Enterprise Provider Database as of August 2015.

The Aetna Vital Savings^SM program (the “Program”) is not insurance. This program does not meet the Minimum Creditable Coverage requirements in Massachusetts. It provides Members with access to discounts at certain health care providers for medical and dental services. These discounts are discounted fees according to schedules negotiated by Aetna Life Insurance Company for the Vital Savings by Aetna discount program. The range of discounts provided under The Program will vary depending on the type of provider and type of service received. The Program does not make payments directly to the participating providers of medical and dental services. Each Member is obligated to pay for all services or products but will receive a discount from those health care providers who have contracted with the Discount Medical Plan Organization to participate in the Program. Aetna may receive a percentage of the fee you pay to the discount vendor. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-877-698-4825, is the Discount Medical Plan Organization.

You are entitled to choose any participating dentist listed in Aetna Dental Access^SM. Dental offices are located throughout the United States. The dental provider listings on DentalPlans.com are provided directly from each dental network or dental program, who are responsible for its accuracy and completeness. These listings are updated on a monthly basis, and every effort has been made to ensure that only participating active providers are listed. We strongly recommend that you confirm that a provider is currently participating before you receive any services from that provider.

This program is based geographically by ZIP code in terms of provider participating and location. Fee schedules and savings may vary by ZIP code and by Provider within a ZIP code.

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