Benefit Summary for AAA Members

An Altus Dental Plan for AAA Members

Annual Maximum: $1,000 per member, per policy year
Annual Deductible: $25 per member for in-network services, $250 per member for out-of network services

Services are covered up to our Maximum Allowable charge.

To be covered, services must be dentally necessary and in accordance with Altus Dental's treatment guidelines. All services must be performed in a dental office.

Preventive/Diagnostic Services
In Network: Plan pays 100%
Out-of-Network: Plan pays 80%*; Deductible applies

  • Two oral exams per policy year
  • Cleanings once every six months
  • Fluoride treatment for children under age 19; once per policy year
  • One set of bitewing x-rays per policy year
  • One complete x-ray series or panoramic film every 60 months
  • Single x-rays as required
  • Sealants for children under age 14, once per unrestored permanent molar every 24 months

Preventive/Diagnostic Services
In Network: Plan pays 80%; Deductible applies
Out-of-Network: Plan pays 64%*; Deductible applies

  • Periodontal maintenance following active therapy - two per year

Basic/Minor Restorative Services
In Network: Plan pays 80%; Deductible applies; 6-month waiting period applies
Out-of-Network: Plan pays 64%*; Deductible applies; 6-month waiting period applies

  • Palliative treatment (minor procedures necessary to relieve acute pain), twice per policy year
  • Amalgam (silver) fillings. Composite (white) fillings on front teeth only. For composite fillings on back teeth, the plan pays up to what would have been paid for an amalgam filling. Patient is responsible for the balance up to the dentist’s charge.
  • Space maintainers for lost deciduous (baby) teeth, replacement limited to once every 60 months
  • Extractions and other routine oral surgeries not covered by a patient’s medical plan
  • General anesthesia or intravenous (IV) sedation for certain complex surgical procedures
  • Root canal therapy
  • Repairs to existing partial or complete dentures once per policy year
  • Recementing crowns or bridges
  • Rebasing or relining of partial or complete dentures; once every 60 months

Major Restorative Services
In Network: Plan pays 80%; Deductible applies; 12-month waiting period applies
Out-of-Network: Plan pays 64%*; Deductible applies; 12-month waiting period applies

  • Root planing and scaling once per quadrant every 24 months
  • Osseous (bone) surgery once per quadrant every 24 months (bone grafts are not covered)
  • Gingivectomies once per site every 24 months
  • Soft tissue grafts once per site every 60 months
  • Crown lengthening once per site every 60 months

Note: A pretreatment estimate is recommended for Major Restorative Services.

Dependent Coverage

Dependent children are covered up until the end of the year that they turn age 19.

*This percentage is based on the reasonable and customary dentist’s charge in a particular geographic area.

To review exclusions & limitations, click here.