Regular, professional dental care is an important part of maintaining your overall health. This year, Pacsun is offering two options for dental coverage: the Basic Dental PPO Plan and the Enhanced PPO Plan. Both plans offer access to the same dental provider network, but they differ in the way they share costs with you. You may choose to visit in- or out-of-network providers and facilities on either plan, however, you will have lower out-of-pocket costs when care is received in-network.
The Basic PPO is a great plan for regular cleanings and fillings, whereas the Enhanced PPO plan offers expanded benefits including Orthodontia, Implants, and Bone Grafts.
Please note: You will not receive an ID card for dental. Let your dentist’s office know you have Aetna and they will confirm your coverage with information like your name, Social Security number, and date of birth. If you would prefer to print an ID card, log on to www.aetna.com.
|BI-WEEKLY CONTRIBUTIONS||BASIC PPO||ENHANCED PPO|
|Associate + Spouse||$22.23||$40.04|
|Associate + Child(ren)||$20.00||$36.04|
|Associate + Family||$33.34||$60.07|
|BENEFITS||BASIC PPO||ENHANCED PPO|
|Plan Year Deductible||$100 per person; $300 family max||$50 per person; $150 family max|
|Plan Year Maximum||$1,000||$2,000|
|Preventive Services||100% covered||100% covered|
|Basic Services||You pay 40% after deductible||You pay 20% after deductible|
|Major Services||You pay 60% after deductible||You pay 50% after deductible|
|Implants||Not covered||Covered as a Major Service|
Adult and Child(ren)
|Not covered||$50 lifetime deductible then 50% coverage;
$1,500 lifetime benefit maximum
If you receive treatment from an out-of-network dentist, they may require you to pay the entire amount at the time of service and then you can submit a claim for reimbursement. If they charge more than the allowed amount, you will be responsible for anything over and above that amount.