Dental Insurance: State of Illinois Mandates Limited Out-Of-Network Benfits for DMO Plan

IIT Human Resources was just notified that effective May 1, 2007, the State of Illinois mandated that Aetna provide an out-of-network benefit for all Dental Maintenance Organization (DMO) plans issued in Illinois. The out-of-network benefit enables Aetna Dental Maintenance Organization (DMO®) members to get some level of coverage when they go to an out-of-network dentist.

DMO members will receive the following coverage when they go to an out-of-network dentist:

• Diagnostic & Preventive: 70%
• Basic: 50%
• Major: 50%
• Individual Deductible: $500 (no family deductible or calendar year max)
• Ortho: 50% with $1,000 deductible

Because the limited out-of-network option is adjudicated differently than regular in-network treatment, Human Resources encourages you to call Aetna at 877.238.6200 prior to treatment to estimate your out-of-pocket responsibility for utilizing the limited out-of network option.

If you have additional questions, please come to one of the scheduled Open Enrollment meetings or contact Human Resources at hr@iit.edu or 312.567.3318.