Department of Defense (Stand Alone Dental Plan) Effective Date: 01-01-2014

Dental Benefits Summary Passive PDN With PDNII Network Annual Deductible* Individual Family of 2 Family of 3 or more Preventive Services Basic Services Major Services Annual Benefit Maximum Office Visit Copay Orthodontic Services (Adult and Child) Orthodontic Deductible Orthodontic Lifetime Maximum *The deductible applies to: Basic & Major services only Waiting Period

$100 $200 $300 100% 80% 50% $2,000 N/A 50% None $1,500 Passive PPO With PPOII Network 12 months for members enrolling in the plan 1/1/10 and after.

Orthodontia (including TMJ appliances) Partial List of Services

Passive PDN With PDNII Network

Preventive 100% Oral examinations (a) 100% Cleanings, including scaling and polishing (a) Adult/Child 100% Fluoride (a) 100% Sealants (permanent molars only) (a) 100% Bitewing Images (a) 100% Full mouth series Images (a) Basic 80% Space Maintainers 80% Amalgam (silver) fillings 80% Composite fillings (anterior teeth only) 80% Stainless steel crowns 80% Incision and drainage of abscess* 80% Uncomplicated extractions 80% Surgical removal of erupted tooth* 80% Surgical removal of impacted tooth (soft tissue)* 80% Surgical removal of impacted tooth (partial bony/ full bony)* 80% General anesthesia/intravenous sedation* Major 50% Root canal therapy 50% Anterior teeth / Bicuspid teeth 50% Scaling and root planing (a) 50% Gingivectomy* 50% Osseous surgery (a)* 50% Inlays 50% Onlays 50% Crowns 50% Full & partial dentures 50% Denture repairs Pontics *Certain services may be covered under the Medical Plan. Contact Member Services for more details. (a) Frequency and/or age limitations may apply to these services. These limits are described in the booklet/certificate.

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Department of Defense (Stand Alone Dental Plan) Effective Date: 01-01-2014

Dental Benefits Summary

Other Important Information This Aetna Dental® Preferred Provider Organization (PDN) benefits summary is provided by Aetna Life Insurance Company for some of the more frequently performed dental procedures. Under the Dental Preferred Provider Organization (PPO) plan, you may choose at the time of service either a PDN participating dentist or any nonparticipating dentist. With the PDN plan, savings are possible because the participating dentists have agreed to provide care for covered services at negotiated rates. Non-participating benefits are subject to usual and prevailing charge limits, as determined by Aetna.

Emergency Dental Care If you need emergency dental care for the palliative treatment (pain relieving, stabilizing) of a dental emergency, you are covered 24 hours a day, 7 days a week. When emergency services are provided by a participating PDN dentist, your co-payment/coinsurance amount will be based on a negotiated fee schedule. When emergency services are provided by a non-participating dentist, you will be responsible for the difference between the plan payment and the dentist's usual charge. Refer to your plan documents for details. Subject to state requirements. Out-of-area emergency dental care may be reviewed by our dental consultants to verify appropriateness of treatment.

Partial List of Exclusions and Limitations* - Coverage is not provided for the following: 1. Services or supplies that are covered in whole or in part: (a) under any other part of this Dental Care Plan; or (b) under any other plan of group benefits provided by or through your employer. 2. Services and supplies to diagnose or treat a disease or injury that is not: (a) a non-occupational disease; or (b) a non-occupational injury. 3. Services not listed in the Dental Care Schedule that applies, unless otherwise specified in the Booklet-Certificate. 4. Those for replacement of a lost, missing or stolen appliance, and those for replacement of appliances that have been damaged due to abuse, misuse or neglect. 5. Those for plastic, reconstructive or cosmetic surgery, or other dental services or supplies, that are primarily intended to improve, alter or enhance appearance. This applies whether or not the services and supplies are for psychological or emotional reasons. Facings on molar crowns and pontics will always be considered cosmetic. 6. Those for or in connection with services, procedures, drugs or other supplies that are determined by Aetna to be experimental or still under clinical investigation by health professionals. 7. Those for dentures, crowns, inlays, onlays, bridgework, or other appliances or services used for the purpose of splinting, to alter vertical dimension, to restore occlusion, or to correct attrition, abrasion or erosion. 8. Those for any of the following services (Does not apply to the DMO plan in TX): (a) an appliance or modification of one if an impression for it was made before the person became a covered person; (b) a crown, bridge, or cast or processed restoration if a tooth was prepared for it before the person became a covered person; or (c) root canal therapy if the pulp chamber for it was opened before the person became a covered person. 9. Services that Aetna defines as not necessary for the diagnosis, care or treatment of the condition involved. This applies even if they are prescribed, recommended or approved by the attending physician or dentist. 10. Those for services intended for treatment of any jaw joint disorder, unless otherwise specified in the Booklet-Certificate. 11. Those for space maintainers, except when needed to preserve space resulting from the premature loss of deciduous teeth. 12. Those for orthodontic treatment, unless otherwise specified in the Booklet-Certificate. 13. Those for general anesthesia and intravenous sedation, unless specifically covered. For plans that cover these services, they will not be eligible for benefits unless done in conjunction with another necessary covered service. 14. Those for treatment by other than a dentist, except that scaling or cleaning of teeth and topical application of fluoride may be done by a licensed dental hygienist. In this case, the treatment must be given under the supervision and guidance of a dentist. 15. Those in connection with a service given to a person age 5 or older if that person becomes a covered person other than: (a) during the first 31 days the person is eligible for this coverage, or (b) as prescribed for any period of open enrollment agreed to by the employer and Aetna. This does not apply to charges incurred: (i) after the end of the 12-month period starting on the date the person became a covered person; or (ii) as a result of accidental injuries sustained while the person was a covered person; or (iii) for a primary care service in the Dental Care Schedule that applies as shown under the headings Visits and Exams, and X-rays and Pathology.

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Department of Defense (Stand Alone Dental Plan) Effective Date: 01-01-2014

Dental Benefits Summary 16. Services given by a nonparticipating dental provider to the extent that the charges exceed the amount payable for the services shown in the Dental Care Schedule that applies. 17. Those for a crown, cast or processed restoration unless: (a) it is treatment for decay or traumatic injury, and teeth cannot be restored with a filling material; or (b) the tooth is an abutment to a covered partial denture or fixed bridge. 18. Those for pontics, crowns, cast or processed restorations made with high-noble metals, unless otherwise specified in the Booklet-Certificate. 19. Those for surgical removal of impacted wisdom teeth only for orthodontic reasons, unless otherwise specified in the Booklet-Certificate. 20. Services needed solely in connection with non-covered services. 21. Services done where there is no evidence of pathology, dysfunction or disease other than covered preventive services. Any exclusion above will not apply to the extent that coverage of the charges is required under any law that applies to the coverage. *This is a partial list of exclusions and limitations, others may apply. Please check your plan booklet for details.

Your Dental Care Plan Coverage Is Subject to the Following Rules: Replacement Rule The replacement of; addition to; or modification of: existing dentures; crowns; casts or processed restorations; removable denture; fixed bridgework; or other prosthetic services is covered only if one of the following terms is met: The replacement or addition of teeth is required to replace one or more teeth extracted after the existing denture or bridgework was installed. This coverage must have been in force for the covered person when the extraction took place. The existing denture, crown; cast or processed restoration, removable denture, bridgework, or other prosthetic service cannot be made serviceable, and was installed at least 5 years before its replacement. The existing denture is an immediate temporary one to replace one or more natural teeth extracted while the person is covered, and cannot be made permanent, and replacement by a permanent denture is required. The replacement must take place within 12 months from the date of initial installation of the immediate temporary denture. The extraction of a third molar does not qualify. Any such appliance or fixed bridge must include the replacement of an extracted tooth or teeth. Tooth Missing But Not Replaced Rule Coverage for the first installation of removable dentures; fixed bridgework and other prosthetic services is subject to the requirements that such removable dentures; fixed bridgework and other prosthetic services are (i) needed to replace one or more natural teeth that were removed while this policy was in force for the covered person; and (ii) are not abutments to a partial denture; removable bridge; or fixed bridge installed during the prior 5 years. Alternate Treatment Rule: If more than one service can be used to treat a covered person’s dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that all of the following terms are met: (a) the service must be listed on the Dental Care Schedule; (b) the service selected must be deemed by the dental profession to be an appropriate method of treatment; and (c) the service selected must meet broadly accepted national standards of dental practice. If treatment is being given by a participating dental provider and the covered person asks for a more costly covered service than that for which coverage is approved, the specific copayment for such service will consist of: (a) the copayment for the approved less costly service; plus (b) the difference in cost between the approved less costly service and the more costly covered service.

Finding Participating Providers Consult Aetna Dentals online provider directory, DocFind®, for the most current provider listings. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna Dental or its affiliates. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. For the most current information, please contact the selected provider or Aetna Member Services at the toll-free number on your ID card, or use our Internet-based provider directory (DocFind) available at www.aetna.com. Specific products may not be available on both a self-funded and insured basis. The information in this document is subject to change without notice. In case of a conflict between your plan documents and this information, the plan documents will govern. In the event of a problem with coverage, members should contact Member Services at the toll-free number on their ID cards for information on how to utilize the grievance procedure when appropriate. All member care and related decisions are the sole responsibility of participating providers. Aetna Dental does not provide health care services and, therefore, cannot guarantee any results or outcomes.

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Department of Defense (Stand Alone Dental Plan) Effective Date: 01-01-2014

Dental Benefits Summary Dental plans are provided or administered by Aetna Life Insurance Company, Aetna Dental Inc., Aetna Dental of California Inc. and/or Aetna Health Inc.

This material is for informational purposes only and is neither an offer of coverage nor dental advice. It contains only a partial, general description of plan or program benefits and does not constitute a contract. The availability of a plan or program may vary by geographic service area. Certain dental plans are available only for groups of a certain size in accordance with underwriting guidelines. Some benefits are subject to limitations or exclusions. Consult the plan documents (Schedule of Benefits, Certificate/Evidence of Coverage, Booklet, Booklet-Certificate, Group Agreement, Group Policy) to determine governing contractual provisions, including procedures, exclusions and limitations relating to your plan.

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Quality health plans & benefits Healthier living Financial well-being Intelligent solutions

Expect more from your dental plan

Aetna Dental® Programs and Discounts 00.02.335.1 F (8/13)

Aetna Dental plans come with these features at no extra cost: • E xtra dental benefits if you have certain health conditions • Access to dental health information and tools • Access to daily dental care products • Savings on vision and hearing care, fitness, weight loss and more

The Aetna Dental DMO benefits and insurance plan is offered, underwritten and/or administered by Aetna Dental Inc., Aetna Dental of California, Inc., Aetna Health Inc. and/or Aetna Life Insurance Company (Aetna), and in Texas by Aetna Dental Inc. In Florida, by Aetna Life Insurance Company. Each insurer has sole responsibility for its own products.

Get more from your Aetna Dental plan

Get extra dental benefits

Save on daily dental care products

There’s a close connection between your dental health and overall health. Researchers are discovering that a healthy mouth may be important to your overall health. That’s especially true if you have a condition like heart disease or diabetes.1

Our research with Columbia shows how periodontal care may help lower medical costs for members with certain health conditions. 2 We are the first dental benefits and insurance company with a published study on the impact dental health has on medical claims. It’s amazing how your mouth can uncover clues about your body.

We include extra dental benefits for members who have a health condition that qualifies. If that’s you, we will invite you to participate in the Aetna Dental/Medical IntegrationSM program.

Look up facts and articles about dental care Simple Steps To Better Dental Health® is your source for dental information, as well as expert opinions from the Columbia University College of Dental Medicine. Learn about conditions, treatments and more. Try our interactive tools. Visit www.simplestepsdental.com.

Dentists can learn, too Columbia faculty helps us put together online dental health courses for our dentists. The courses help keep dentists up-to-date with dental care standards. Dentists can learn how to help their patients quit smoking, treat gum disease and more.

Check out the healthy savings from Waterpik® Waterpik flossers are a great way to keep your smile healthy. You can save on these easy-to-use products: • Waterpik 450 Cordless Plus Water Flosser with Case and Waterpik 100 Ultra Water Flosser — Easier to use and more effective than string floss at improving gum health. • Water Flosser for Kids – WP-260 — A customized model for children ages 6+, with a small and simple design that makes water flossing easy. It’s perfect for any kid who has braces or has trouble flossing.

Save on cavity-fighting gum, mouthwash and more from Epic Dental You can save on a variety of Epic products that contain xylitol — a natural sweetener shown to stop tooth decay. 3 You can get discounts on gum, toothpaste, mouthwash and more. Fight cavities and keep smiling.

Oral Health and Your Body: The Mouth Body Connection. Available at: www.simplestepsdental.com/SS/ihtSS/r.WSIHW000/ st.31848/t.32629/pr.3.html. Accessed May 3, 2013. 2 An examination of periodontal treatment and per member per month medical costs in an insured population. BMC Health Services Research. August 16, 2006;6:103. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC1574303. Accessed May 20, 2013. 3 Brian A. Burt, The use of sorbitol- and xylitol-sweetened chewing gum in caries control, J Am Dent Assoc 2006 137: 190-196. 1

Save on other health and wellness products and services At-home products discounts

Vision discounts

Save on products and services for your home and family that best fit your needs and your life, such as the Omron 7 Series™ Upper Arm Blood Pressure Monitor. You can track your blood pressure accurately and comfortably.

Save on eye exams, eyeglasses, contact lenses — even LASIK surgery — with vision discounts from EyeMed.6 Choose from popular designer frames.7 Plus, you can get discounts on vision items that don’t need a prescription — like the perfect pair of sunglasses.

Book discounts Save on books, DVDs and more through the American Cancer Society Bookstore and the Mayo Clinic Bookstore. You can also get discounts on yoga DVDs and books from Pranamaya.

Fitness discounts You can look and feel better while improving your health and saving money. Save on gym memberships4 and name-brand home fitness and nutrition products that support a healthy lifestyle, with services provided by GlobalFit®.

Visit national chains like Pearle Vision®, LensCrafters®, JCPenney® Optical, Target Optical® and participating Sears Optical® locations. Or go to any of the thousands of eye doctors in private practices. To find one near you, visit www.aetna.com. Or call 1-800-793-8616.

Weight management discounts

Hearing discounts

Trim your waist, not your wallet! Save on some of today’s most popular weight-loss programs and diet and meal plans from CalorieKing®, eDiets®, Jenny Craig® and Nutrisystem®. Enjoy one-on-one help, personalized menus, online tools, chat rooms and more.

Pay less for hearing aids, exams and more. Choose from leading manufacturers. Enjoy discounts on hearing aid batteries mailed to your home. You also get free follow-up service for one year.

Discounts are not insurance. The discounts give you access to vendors who have agreed to give Aetna Dental plan members discounted prices on their products and services. You pay the full, discounted price directly to the vendor.

Natural products and services discounts Save on standard charges for acupuncture, chiropractic, massage therapy and nutrition services through the ChooseHealthy®5 program. And get a discount on a wide variety of health and wellness products at www.choosehealthy.com.

Because discounts are not insurance, there are no claims, no referrals, and no limits on how often you can get the discounts. Discount offers are not guaranteed and may be discontinued at any time. Discounts are in addition to any plan benefits. These discounts are subject to change without notice.

Through Vital Health Network, save on online consultations and alternative remedies provided by naturopathic or integrated medicine physicians for a variety of conditions. Need more good news? You never have to mail a claim form!

Participation is for new gym members only. If you belong to a gym now or belonged recently, call GlobalFit to see if a discount applies. 5 The ChooseHealthy program is made available through American Specialty Health Systems, Inc. (ASH Systems), a subsidiary of American Specialty Health Incorporated (ASH). ChooseHealthy is a federally registered trademark of ASH and used with permission herein. 6 Based on EyeMed Services and Compensation Schedule, 12/10. Prices are subject to change. Discounts may not be available on certain brand-name vision materials (such as designer eyeglass frames) in which the manufacturer imposes a no-discount practice. 7 Certain brands impose a no-discount policy. 4

Click to get started!

Call for answers!

Everything you need to know about your Aetna Dental benefits is at your fingertips.

Member Services representatives are also standing by to answer any questions you may have. Just call the toll-free number on your Aetna Dental member ID card, once you become a member. Toll-free member phone lines are available 24/7.

Manage your dental benefits online Make the most of your dental plan. You can use your Aetna Navigator® website to manage your dental care and costs. See details about your plan, get an ID card and review your claims. Compare costs for dentists and specialists. And so much more. Register today at www.aetna.com. Find a network dentist almost anywhere We make it easy to find a network dentist with our DocFind® directory. • Before you enroll — Visit www.aetna.com and click Find a Doctor. • After you enroll — Access DocFind through Aetna Navigator to simplify your search with prefilled fields. Get personalized health information — in one easy search The Aetna SmartSourceSM tool is personalized based on your health plan, location and more. We organize the results so you find what you need. You can read articles. Find dentists near you who treat your condition. Get cost estimates for care. And learn about programs and discounts.

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Dental Service Centers Get help from claims, customer service and clinical management professionals who have been on the job with us an average of 11 years. And they’ve exceeded customer service goals every month for more than 100 months.8 Speak another language? Representatives are ready to help with interpreters who can talk to you in 140 languages. Oral Surgery Center of Excellence Our specialized oral surgery team can help you with your treatment questions.

Aetna Dental Customer Service Objectives. Reported from January 2003 to present.

Enroll in an Aetna Dental benefits and insurance plan to get all these extras! All of these programs, discounts and resources come with your dental benefits from Aetna. Already a member? Log in to Aetna Navigator to learn more or get started.

This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Discount offers provide access to discounted prices and are not part of an insured plan or policy. The member is responsible for the full cost of the discounted services. Aetna may receive a percentage of the fee you pay to a discount vendor. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Health and Dental information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Aetna does not provide care or guarantee access to health and dental care services. Aetna does not endorse any vendor, product or service associated with discount offers. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com. Policy forms issued in Oklahoma include: GR-9/GR-9N, GR-23, GR-29/GR-29N and/or GR-96402- 02 04-09.

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Save big on dental costs Aetna Dental® PPO Plans There’s a great way to save on dental care costs. See a dentist who participates in your preferred provider organization (PPO) dental plan. Only participating dentists offer special rates to Aetna members for covered care.* That means your costs are typically lower when you see a participating dentist. You can save on non-covered services, too. Cosmetic teeth whitening and more. So start saving! See a dentist who participates in our dental network today.**

Want an idea of what you can save? Compare the costs of in- and out-of-network care***

Product/service

Out of network

In network

You pay†

You pay†

Total savings†

Extraction (single tooth) Plan pays 80%

$37.40

$17.00

$20.40

Composite filling Plan pays 80%

$34.60

$18.00

$16.60

Complete upper denture Plan pays 50%

$618.50

$458.00

$160.50

Molar root canal Plan pays 50%

$547.00

$379.50

$167.50

Crown Plan pays 50%

$583.00

$387.00

$196.00

See a dentist who participates in your plan and save.

*You may need to pay the difference between what your dentist charges and what the plan pays. Your plan may have annual and lifetime maximums for services. There are also age and frequency limits for certain services. See your plan documents for details. **Discounts for non-covered services may not be available in all states. ***Based on a 100/80/50 dental plan with a $50 yearly deductible. Chart shows average charges after deductible has been paid. † Represents average fees for the procedures listed as displayed in the Aetna Estimate the Cost of Care tool as of September 2012 for Los Angeles, Orlando, Chicago and New York City. Actual costs and savings may vary by geographic location. 07.03.304.1 G (8/13)

See a participating PPO dentist when you need care

See how much you can save

You may save 10 to 40 percent off the usual cost of dental care. For costly services, such as crowns or root canals, you may save more than $120 on a single procedure.*

• Get estimated average costs for cleanings, fillings, X-rays, crowns, dentures and more. • See how much you may save by visiting a dentist in our network.

Seeing a participating dentist can help you: • Save on dental care costs • Extend your yearly plan maximum

Visit our Estimate the Cost of Care tool:

Here’s how you do it:

Visit our DocFind® online directory at www.aetna.com. Search by:

• Log in to your secure member website at www.aetna.com • Click Take Action on Your Health • Select Cost of Care • Under Other Services, select Dental Procedures • Click the procedure you want to price • You’ll see a comparison of in- and out-of-network costs

• Dentist name • Specialty • ZIP code • Miles and more

See a participating PPO dentist and start saving.

So why pay more?

Find a network dentist almost anywhere

You can find maps and directions to your dentist’s office, too. Choose from nearly 205,000 available PPO dental-practice locations.**

*Based on 2009 dental provider contracts. **A s of June 1, 2013, based on Aetna provider data. Dental PPO plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). This material is for information only and is not an offer or invitation to contract. An application must be obtained to obtain coverage. Rates and benefits vary by location. Dental insurance plans contain exclusions and limitations. Dental information programs provide general dental information and are not a substitute for diagnosis or treatment by a dentist or other dental care professional. Dental providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to dental services. Dental insurance plans contain exclusions and limitations. Not all dental services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and/or group size and are subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com. Policy forms issued in Oklahoma include: GR-9 and/or GR-9N, GR-23, GR-29 and/or GR-29N.

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Quality health plans & benefits Healthier living Financial well-being Intelligent solutions

Freedom to choose any licensed dentist Aetna Dental® PPO* Plan In network or out — it’s always your choice The options

Pick your dentist

How it works

In network It’s simple. It’s affordable.

Visit a dentist from the Aetna Dental PPO network.

• Just show your Aetna ID card when you go. Network dentists file claims for you.

Out of network It’s flexible.

Go to any licensed dentist outside the network.

• Since network dentists offer special rates for covered services, your share of the cost is usually lower. • Dentists who aren’t in the network may have higher rates than in-network dentists.** • You may have to file your own claim forms.

*In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). **Out-of-network benefits are paid based on usual and prevailing charges or recognized charge levels, as determined by Aetna and specified in your plan. 07.02.304.1 J (8/13)

See if your dentist is in the Aetna Dental PPO network There are two ways to find a network dentist. • Online — visit our DocFind® directory at www.aetna.com. • By phone — after you enroll, you can call Member Services at the toll-free number on your Aetna ID card.

Check the summary of benefits for coverage amounts Each group dental insurance plan is different. Please check your summary of benefits for the details that apply to you. Your share of the costs may include: • Deductible — the dollar amount some plans require you to pay for services before coverage begins. • Coinsurance — your percent share of the cost. For example, if the plan covers 80%, then your “coinsurance” will be 20% of the cost. You may have annual and lifetime limits on coverage. And there may be age and frequency limits on certain services.

Dental benefits online and on the go Your secure, personalized member website When you’re an Aetna member, you get tools and resources to help manage your dental health and your benefits. All of your plan information and cost-savings tools are in one place — your Aetna Navigator® member website. When you sign up and use it, you’re not just a member, you’re a navigator. Navigators are smart about their dental care. Sign up today at www.aetna.com. Look up facts and articles about dental care Simple Steps To Better Dental Health® is your source for dental information, as well as expert opinions from the Columbia University College of Dental Medicine. Learn about conditions, treatments and more. Try our interactive tools. Visit www.simplestepsdental.com.

Find what you need — wherever, whenever The Aetna Mobile app puts our most popular online features at your fingertips. It’s available for iPhone® and Android™ mobile devices. Scan this code now to download. Or visit www.aetna.com/mobile.

Enroll in the dental plan that lets you visit any licensed dentist — in or out of the network.

Dental PPO insurance plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Rates and benefits vary by location. Dental insurance plans contain exclusions and limitations. Not all dental services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and/or group size and are subject to change. Dental providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to dental services. Dental information programs provide general dental information and are not a substitute for diagnosis or treatment by a dentist or other dental care professional. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com. Policy forms issued in Oklahoma include: GR-9/GR-9N, GR-23 and/or GR-29/GR-29N.

www.aetna.com ©2013 Aetna Inc. 07.02.304.1 J (8/13)