Dental Health Maintenance Organizations (DHMOs)
A DHMO is a network of dentists and specialists who provide dental care services at a fixed cost. With the DHMO, a participant does not have to meet a deductible or file any claim forms. The DHMO is available only in areas where there are participating dentists.
On This Page:
How the DHMOs Work
When a participant enrolls in a DHMO, he or she, as well as his or her dependents, must choose a primary care dentist. Each covered person may select his or her own primary care dentist. This primary care dentist will provide all routine dental care and will refer the participant to a network specialist whenever he or she needs specialty care.
For routine dental care — such as check-ups or fillings — a participant should make an appointment with his or her primary care dentist. When the participant goes in for the visit, he or she will pay the required copayment for covered services. The participant does not have to file a claim form after receiving care.
If a participant receives dental care without going through his or her primary care dentist first, or if the participant's care is not authorized by the plan, the DHMO will not pay any benefits. The participant will pay the full cost of any out-of-network or unauthorized care.
Choosing a Primary Care Dentist
The participant and each dependent must select a primary care dentist from the DHMO's network of providers.
Each participant can change his or her primary care dentist at any time during the year. To select or change a primary care dentist, a participant can call the Member Services number on the back of his or her ID card.
ID Cards
Participants in a DHMO will receive an ID card in the mail. This ID card contains important information about the participant, as well as about the DHMO in which he or she is enrolled.
A participant must present his or her ID card whenever going to the dentist's office. By presenting the card, the participant ensures that he or she will receive the correct level of coverage.
What the DHMOs Cover
The DHMOs generally cover preventive, basic and major services. The DHMOs also generally cover orthodontia services.
Refer to a DHMO's certificate of coverage for a complete list of what is covered by the plan.
DHMO Benefit Charts and Evidences of Coverage
For highlights of each DHMO, participants can use the following links:
| DHMO | 2009 | Detailed Plan Information |
|---|---|---|
| Aetna DMO® — Arizona | 2009 (29k) | Evidence of Coverage (907k) |
| Aetna DMO® — California | 2009 (29k) | Evidence of Coverage (124k) |
| Aetna DMO® — Massachusetts | 2009 (29k) | Evidence of Coverage (112k) |
| Aetna DMO® — New Jersey | 2009 (29k) | Evidence of Coverage (176k) |
| Aetna DMO® — Oklahoma | 2009 (29k) | Evidence of Coverage (112k) |
| Aetna DMO® — Other States | 2009 (29k) | Evidence of Coverage (172k) |
| Aetna DMO® — Texas | 2009 (29k) | Evidence of Coverage (120k) |
| CIGNA Dental Health | 2009 (29k) | Evidence of Coverage (669k) |
| Dominion Dental Plan | 2009 (29k) | Evidence of Coverage (66k) |
| CIGNA International Dental Plan | 2009 (29k) | Evidence of Coverage (413k) |