Benefit Summary for AAA Members

An Altus Dental Plan for AAA Members

Annual Maximum: $1,000 per person, per calendar year
Annual deductible: $0 per person (In-Network); $25 per person (Out-of-Network)
Orthodontic lifetime maximum: $1,000 per dependent child.

In Network: Services are covered up to our Maximum Allowable charge.
Out-of-Network: We will pay 80% of the in network coverage level (listed below under "Plan Pays") for that type of service for in network use, based on the reasonable and customary charge in a particular geographic area. You are responsible for the difference between our payment and the non-participating dentist's 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.

Note: Pre-treatment Estimates are recommended for underlined procedures.

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

One oral exam per calendar year
Cleaning once every 6 months
Fluoride treatment for children under age 19; once per calendar year
One set of bitewing x-rays per calendar year
One complete x-ray series or panoramic film every 60 months
Single x-rays as required

Basic/Minor Restorative Services
In Network: Plan pays 70%
Out-of-Network: Plan pays 56%*

Sealants for children under age 14 once per unrestored permanent molar every 36 months
Palliative treatment (minor procedures necessary to relieve acute pain), twice per calendar 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.
Space maintainers for lost deciduous (baby) teeth, replacement limited to once every 60 months
Extractions and other routine oral surgery when 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 calendar year
Recementing crowns or bridges
Rebasing or relining of partial or complete dentures once every 60 months
Periodontal maintenance following active therapy - two per year

Major Restorative Services - There is a 12-month waiting period for Major Restorative services for each eligible member. Pre-treatment estimate is recommended.
In Network: Plan pays 50%
Out-of-Network: Plan pays 40%*

Crowns over natural teeth, build-ups, post and cores – replacement limited to once every 60 months
Bridges, build-ups, posts and cores – replacement limited to once every 60 months
Partial and complete dentures – replacement limited to once every 60 months
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

Orthodontics - There is a 12-month waiting period for orthodontic services for each eligible dependent child enrolled in an Altus Dental family plan.
In Network: Plan pays 50%
Out-of-Network: Plan pays 40%*

Braces and related services for dependent children under the age of 19

Note: Orthodontic services are only available for dependent children under the age of 19 who are enrolled in an Altus Dental family plan through AAA prior to beginning orthodontic treatment.

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

*This percentage is based on the reasonable and customary dentists' charge in a particular geographic area.

To review exclusions & limitations click here.