Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutions

Freedom to choose any dentistAetna Dental® PPO Plan

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*In Texas, the preferred provider organization (PPO) plan is known as the participating dental network (PDN).** Out-of-network benefits are paid based on usual and prevailing charges or recognized charge levels, as determined

by Aetna and specified in your plan documents.

Your options Pick your dentist How it works

In network No paperwork Lower costs

Visit a dentist from the Aetna Dental PPO* network.

• Network dentists offer special rates for covered services. So your share of the cost is usually lower.

• Network dentists file claims for you.

Out of network Choice

Go to any licensed dentist outside the network.

• You may pay more when you get care from dentists who aren’t in the network.**

• You may have to file your own claims.

In network or out — it’s your choice

The Aetna Mobile app puts our most popular online features at your fingertips. It’s available for iPhone® and Android™ mobile devices.

Visit www.aetna.com/mobile.

Find what you need — wherever, whenever

Dental PPO insurance plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna).Apple, the Apple logo and iPhone are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Android and Google Play are trademarks of Google Inc.This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Rates and benefits vary by location. Dental insurance plans contain exclusions and limitations. Not all dental services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and/or group size and are subject to change. Dental providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to dental services. Dental information programs provide general dental information and are not a substitute for diagnosis or treatment by a dentist or other dental care professional. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com.Policy forms issued in Oklahoma include: GR-9/GR-9N, GR-23 and/or GR-29/GR-29N.

www.aetna.com

©2014 Aetna Inc. 07.02.304.1 K (8/14)

Choosing your dental plan

See if your dentist is in the networkYou may want to make sure your dentist is in our network. It’s easy. Use our online directory at www.aetna.com to search.

Check for your costsGroup dental insurance plans are all different. That’s why you won’t see your specific cost information here. Instead, check the benefits summary that comes with your plan materials to find your share of the costs. This may include your:

Deductible — the dollar amount some plans require you to pay for services before coverage begins.

Coinsurance – the percent of health care expenses you pay after your deductible. Your health plan pays the rest. For instance, you pay 20 percent, and your plan pays 80 percent.

Your dental plan may have annual and lifetime limits on coverage. And there may be age and frequency limits on some services.

Extra online help

Get your informationWhen you’re an Aetna member, you get tools and resources to help you manage your health and your benefits. All of your plan information and cost-saving tools are in one place — your secure member website. Sign up today at www.aetna.com.

And get tips for a brighter, healthier smile Check out our dental articles and interactive tools. You’ll find topics ranging from fillings and flossing to dentures … and more. Plus, get expert opinions from the Columbia University College of Dental Medicine, as well as the latest dental news. Visit www.simplestepsdental.com.

Something new this year: no more ID cards

Instead, when you visit the dentist’s office, just give your personal information. But if you want a card, no problem. Once you enroll, you can get one by logging in to your member website at www.aetna.com, using our mobile app or calling Member Services.

Sign up today for the dental plan that lets you visit any licensed dentist — in or out of the network.

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Participating Non-participating Annual Deductible* Individual $50 $50 Family $150 $150 Preventive Services 100% 100% Basic Services 80% 65% Major Services 50% 50% Annual Benefit Maximum $1,000 $1,000 Office Visit Copay N/A N/A Orthodontic Services** 50% 35% Orthodontic Deductible None None Orthodontic Lifetime Maximum $1,000 $1,000

Partial List of Services

Preventive Participating Non-participating Oral examinations (a) 100% 100%Cleanings (a) Adult/Child 100% 100%Fluoride (a) 100% 100%Sealants (permanent molars only) (a) 100% 100%Bitewing Images (a) 100% 100%Full mouth series Images (a) 100% 100%Space Maintainers 100% 100%

BasicRoot canal therapy

Anterior teeth / Bicuspid teeth 80% 65%Scaling and root planing (a) 80% 65%Gingivectomy* 80% 65%Amalgam (silver) fillings 80% 65%Composite fillings (anterior teeth only) 80% 65%Stainless steel crowns 80% 65%Incision and drainage of abscess* 80% 65%Uncomplicated extractions 80% 65%Surgical removal of erupted tooth* 80% 65%Surgical removal of impacted tooth (soft tissue)* 80% 65%

MajorInlays 50% 50%Onlays 50% 50%Crowns 50% 50%Full & partial dentures 50% 50%Pontics 50% 50%Root canal therapy, molar teeth 50% 50%Osseous surgery (a)* 50% 50%Surgical removal of impacted tooth (partial bony/ full bony)* 50% 50%General anesthesia/intravenous sedation* 50% 50%Denture repairs 50% 50%

Dental Benefits Summary

With PPOII Network

The Non-Participating deductible applies to: Preventive, Basic, & Major services only

With PPOII Network

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(a) Frequency and/or age limitations may apply to these services. These limits are described in the booklet/certificate.

Active PPO

Active PPO

*The Participating deductible applies to: Basic & Major services only

**Orthodontia is covered only for children (appliance must be placed prior to age 20).

*Certain services may be covered under the Medical Plan. Contact Member Services for more details.

Effective Date: 07-01-2015

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Dental Benefits Summary

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Effective Date: 07-01-2015

This Aetna Dental® Preferred Provider Organization (PPO) benefits summary is provided by Aetna Life Insurance Company for some of the more frequently performed dental procedures. Under the Dental Preferred Provider Organization (PPO) plan, you may choose at the time of service either a PPO participating dentist or any nonparticipating dentist. With the PPO plan, savings are possible because the participating dentists have agreed to provide care for covered services at negotiated rates. Non-participating benefits are subject to usual and prevailing charge limits, as determined by Aetna.

(b) under any other plan of group benefits provided by or through your employer.

If you need emergency dental care for the palliative treatment (pain relieving, stabilizing) of a dental emergency, you are covered 24 hours a day, 7 days a week.

Emergency Dental Care

12. Those for orthodontic treatment, unless otherwise specified in the Booklet-Certificate.

1. Services or supplies that are covered in whole or in part:(a) under any other part of this Dental Care Plan; or

Partial List of Exclusions and Limitations* - Coverage is not provided for the following:

When emergency services are provided by a participating PPO dentist, your co-payment/coinsurance amount will be based on a negotiated fee schedule. When emergency services are provided by a non-participating dentist, you will be responsible for the difference between the plan payment and the dentist's usual charge. Refer to your plan documents for details. Subject to state requirements. Out-of-area emergency dental care may be reviewed by our dental consultants to verify appropriateness of treatment.

7. Those for dentures, crowns, inlays, onlays, bridgework, or other appliances or services used for the purpose of splinting, to alter vertical dimension, to restore occlusion, or to correct attrition, abrasion or erosion.

3. Services not listed in the Dental Care Schedule that applies, unless otherwise specified in the Booklet-Certificate.4. Those for replacement of a lost, missing or stolen appliance, and those for replacement of appliances that have been damaged due to abuse, misuse or neglect.5. Those for plastic, reconstructive or cosmetic surgery, or other dental services or supplies, that are primarily intended to improve, alter or enhance appearance. This applies whether or not the services and supplies are for psychological or emotional reasons. Facings on molar crowns and pontics will always be considered cosmetic.6. Those for or in connection with services, procedures, drugs or other supplies that are determined by Aetna to be experimental or still under clinical investigation by health professionals.

2. Services and supplies to diagnose or treat a disease or injury that is not:(a) a non-occupational disease; or(b) a non-occupational injury.

9. Services that Aetna defines as not necessary for the diagnosis, care or treatment of the condition involved. This applies even if they are prescribed, recommended or approved by the attending physician or dentist.10. Those for services intended for treatment of any jaw joint disorder, unless otherwise specified in the Booklet-Certificate.

11. Those for space maintainers, except when needed to preserve space resulting from the premature loss of deciduous teeth.

(b) a crown, bridge, or cast or processed restoration if a tooth was prepared for it before the person became a covered person; or(c) root canal therapy if the pulp chamber for it was opened before the person became a covered person.

8. Those for any of the following services (Does not apply to the DMO plan in TX):(a) an appliance or modification of one if an impression for it was made before the person became a covered person;

(i) after the end of the 12-month period starting on the date the person became a covered person; or(ii) as a result of accidental injuries sustained while the person was a covered person; or(iii) for a primary care service in the Dental Care Schedule that applies as shown under the headings Visits and Exams, and X-rays and Pathology.

13. Those for general anesthesia and intravenous sedation, unless specifically covered. For plans that cover these services, they will not be eligible for benefits unless done in conjunction with another necessary covered service.14. Those for treatment by other than a dentist, except that scaling or cleaning of teeth and topical application of fluoride may be done by a licensed dental hygienist. In this case, the treatment must be given under the supervision and guidance of a dentist.15. Those in connection with a service given to a person age 5 or older if that person becomes a covered person other than:

(a) during the first 31 days the person is eligible for this coverage, or (b) as prescribed for any period of open enrollment agreed to by the employer and Aetna. This does not apply to charges incurred:

Other Important Information

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Dental Benefits Summary

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Effective Date: 07-01-2015

The extraction of a third molar does not qualify. Any such appliance or fixed bridge must include the replacement of an extracted tooth or teeth.

20. Services needed solely in connection with non-covered services.21. Services done where there is no evidence of pathology, dysfunction or disease other than covered preventive services.

16. Services given by a nonparticipating dental provider to the extent that the charges exceed the amount payable for the services shown in the Dental Care Schedule that applies.17. Those for a crown, cast or processed restoration unless:

(a) it is treatment for decay or traumatic injury, and teeth cannot be restored with a filling material; or (b) the tooth is an abutment to a covered partial denture or fixed bridge.

Replacement RuleThe replacement of; addition to; or modification of: existing dentures; crowns; casts or processed restorations; removable denture; fixed bridgework; or other prosthetic services is covered only if one of the following terms is met:

Any exclusion above will not apply to the extent that coverage of the charges is required under any law that applies to the coverage.*This is a partial list of exclusions and limitations, others may apply. Please check your plan booklet for details.

Your Dental Care Plan Coverage Is Subject to the Following Rules:

18. Those for pontics, crowns, cast or processed restorations made with high-noble metals, unless otherwise specified in the Booklet-Certificate.19. Those for surgical removal of impacted wisdom teeth only for orthodontic reasons, unless otherwise specified in the Booklet-Certificate.

Coverage for the first installation of removable dentures; fixed bridgework and other prosthetic services is subject to the requirements that such removable dentures; fixed bridgework and other prosthetic services are (i) needed to replace one or more natural teeth that were removed while this policy was in force for the covered person; and (ii) are not abutments to a partial denture; removable bridge; or fixed bridge installed during the prior 8 years.

Alternate Treatment Rule: If more than one service can be used to treat a covered person’s dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that all of the following terms are met: (a) the service must be listed on the Dental Care Schedule; (b) the service selected must be deemed by the dental profession to be an appropriate method of treatment; and (c) the service selected must meet broadly accepted national standards of dental practice.

If treatment is being given by a participating dental provider and the covered person asks for a more costly covered service than that for which coverage is approved, the specific copayment for such service will consist of:

(b) the difference in cost between the approved less costly service and the more costly covered service.

Finding Participating ProvidersConsult Aetna Dentals online provider directory, DocFind®, for the most current provider listings. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna Dental or its affiliates. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change without notice. For the most current information, please contact the selected provider or Aetna Member Services at the toll-free number on your online ID card, or use our Internet-based provider directory (DocFind) available at www.aetna.com.

(a) the copayment for the approved less costly service; plus

Specific products may not be available on both a self-funded and insured basis. The information in this document is subject to change without notice. In case of a conflict between your plan documents and this information, the plan documents will govern.

Reinstatement Rule: If your Employee and Dependents coverage terminates because your contributions are not paid when due, you may not be covered again for a period of two years from the date your coverage terminates. If you are in an eligible class, you may re-enroll yourself and your eligible dependents at the end of such two-year period. Your dental coverage will be effective as described in the Effective date of Coverage section of the Booklet-Certificate. Your dental coverage will be subject to any rules that apply to a person who enrolls after the first 31 days the person is eligible for the coverage.

The replacement or addition of teeth is required to replace one or more teeth extracted after the existing denture orbridgework was installed. This coverage must have been in force for the covered person when the extraction took place.

The existing denture, crown; cast or processed restoration, removable denture, bridgework, or other prosthetic service cannot be made serviceable, and was installed at least 8 years before its replacement.

The existing denture is an immediate temporary one to replace one or more natural teeth extracted while the person is covered, and cannot be made permanent, and replacement by a permanent denture is required. The replacement must take place within 12 months from the date of initial installation of the immediate temporary denture.

Tooth Missing But Not Replaced Rule

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Dental Benefits Summary

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Effective Date: 07-01-2015

In Texas, the Dental Preferred Provider Organization (PPO) is known as the Participating Dental Network (PDN), and is administered by Aetna Life Insurance Company.

In the event of a problem with coverage, members should contact Member Services at the toll-free number on their online ID cards for information on how to utilize the grievance procedure when appropriate.All member care and related decisions are the sole responsibility of participating providers. Aetna Dental does not provide health care services and, therefore, cannot guarantee any results or outcomes.

Dental plans are provided or administered by Aetna Life Insurance Company, Aetna Dental Inc., Aetna Dental of California Inc. and/or Aetna Health Inc.

This material is for informational purposes only and is neither an offer of coverage nor dental advice. It contains only a partial, general description of plan or program benefits and does not constitute a contract. The availability of a plan or program may vary by geographic service area. Certain dental plans are available only for groups of a certain size in accordance with underwriting guidelines. Some benefits are subject to limitations or exclusions. Consult the plan documents (Schedule of Benefits, Certificate/Evidence of Coverage, Booklet, Booklet-Certificate, Group Agreement, Group Policy) to determine governing contractual provisions, including procedures, exclusions and limitations relating to your plan.

Quality health plans & benefitsHealthier livingFinancial well-beingIntelligent solutions

Enjoy the extras — at no extra cost

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Aetna Dental® Programs and Discounts

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Aetna Dental plans come with some really nice features — at no added cost

When you enroll in any of our dental benefits and insurance plans, you get:

• Extra dental benefits if you have specific health conditions

• Online tools for keeping smiles healthier — and managing dental benefits

• Access to savings on daily dental-care products, vision and hearing care, fitness, weight loss and more

1 Oral Health and Your Body: The Mouth-Body Connection. Available at: www.simplestepsdental.com/SS/ihtSS/r.WSIHW000/st.31848/t.32629/pr.3.html. Accessed February 15, 2014.

2 An examination of periodontal treatment and per member per month medical costs in an insured population. BMC Health Services Research. August 16, 2006; 6: 103. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC1574303. Accessed February 17, 2014.

3 Guideline on Xylitol Use in Caries Prevention. American Academy of Pediatric Dentistry, Council on Clinical Affairs. 2011; 35 (No. 6). Available at: www.aapd.org/media/policies_guidelines/g_xylitoluse.pdf. Accessed March 18, 2014.

The Aetna Dental DMO benefits and insurance plan is offered, underwritten and/or administered by Aetna Dental Inc., Aetna Health Inc. and/or Aetna Life Insurance Company (Aetna), and in Texas, by Aetna Dental Inc. In Florida, by Aetna Life Insurance Company. Each insurer has sole responsibility for its own products.

Extra dental benefits

Researchers are finding that a healthy mouth may be important to your overall health. That’s especially true if you have a condition like heart disease or diabetes.1 So we have a special program to help. It includes extra dental benefits for members who have a health condition that qualifies under the program. If that’s you, we’ll ask you to participate.

Tips for a brighter, healthier smile

Check out our dental articles and interactive tools. You’ll find topics ranging from fillings and flossing to dentures … and more. Plus, get expert opinions from the Columbia University College of Dental Medicine. And the latest dental news, too. Visit www.simplestepsdental.com.

Dentist extras for healthier outcomes

Columbia faculty helps us put together online dental courses for dentists in the Aetna network. The courses help the dentists keep up with the latest dental care standards. Topics range from helping patients quit smoking to treating gum disease. The focus is on healthier outcomes for members.

Discounts on products for daily dental care

Our research with Columbia shows how oral care helps lower medical costs for our members with specific health conditions.2 That’s why we offer special costs on some dental products for daily use. They’re available through the secure member website at www.aetna.com.

Save on Epic Dental cavity-fighting productsSave on products that contain xylitol. It’s a natural sweetener shown to stop tooth decay.3 There are discounts on gum, toothpaste, mouthwash and more. Fight cavities and keep smiling.

Save on Waterpik® productsWho doesn’t love a clean, healthy mouth? With Aetna Dental, you also save on Waterpik oral health care products.

Make the most of dental add-ons

* Participation is for new gym members only. If you belong to a gym now or belonged recently, call GlobalFit to see if a discount applies.

** The ChooseHealthy program is made available through American Specialty Health Administrators, Inc. (ASH Administrators), a subsidiary of American Specialty Health Incorporated (ASH). ChooseHealthy is a federally registered trademark of ASH and used with permission herein.

*** Certain brands impose a no-discount policy.

Aetna members also can get deals on products and services for healthy living. To use these discounts, sign up for your member website at www.aetna.com.

At home products

Save on Omron blood pressure monitors and more.

Books

Save on books, DVDs and more through the American Cancer Society Bookstore and the Mayo Clinic Bookstore. You can also get discounts on yoga DVDs and books from Pranamaya.

Fitness

Look and feel better for less. Save on gym memberships* and name-brand home fitness and nutrition products that support a healthy lifestyle, with services provided by GlobalFit®.

Hearing

Pay less for hearing aids, hearing aid batteries mailed to your home, exams and more. Choose from leading manufacturers. You also get free follow-up service for one year.

Natural products and services

Get a discount off the normal fee for acupuncture, chiropractic, massage therapy and nutrition services through the ChooseHealthy® program.** And get a discount on a variety of health and wellness products.

Through Vital Health Network, there are savings on online consultations and alternative remedies provided by naturopathic or integrated medicine doctors for a variety of conditions. No claims forms needed.

Vision

Taking care of your eyes cost you less with Aetna’s vision discounts. You can choose from popular designer frames*** and get discounts on vision items that don’t need a prescription.

Just visit national chains like Pearle Vision®, LensCrafters®, JCPenney Optical, Target Optical® and participating Sears Optical® locations. Or go to any of the thousands of eye doctors in private practices. To find a vision provider near you, search our online directory at www.aetna.com.

Weight management

Save on some of today’s most popular weight-loss programs and meal plans from CalorieKing®, Jenny Craig® and Nutrisystem®. Enjoy one-on-one help, personalized menus, online tools, chat rooms and more.

What to know about the discounts

Discounts are a great way to save money. But they’re not insurance. Instead, with a discount, you get access to a vendor who has agreed to give Aetna Dental plan members discounted prices on products and services. You pay the full discounted price directly to the vendor.

Because discounts aren’t insurance, you don’t have to worry about claims or referrals. And there are no limits on how often you can use them. Discount offers are not guaranteed and may be stopped at any time. Discounts are in addition to any plan benefits. These discounts may change without notice.

Enjoy discounts for healthy living

The Aetna Mobile app puts our most popular online features at your fingertips. It’s available for iPhone® and Android™ mobile devices.

Visit www.aetna.com/mobile.

Get extra help online

Find a network dentistDentists in the Aetna network offer special rates for covered services. So your share of the cost is usually lower. To check for network dentists, use our online directory. Visit www.aetna.com.

Make the most of your dental planWhen you’re an Aetna member, you get tools and resources to help manage your dental health and your benefits. All of your plan information and cost-saving tools are in one place — your secure member website. It lets you:

• See details about your plan

• Review your claims

• Compare costs for dentists and specialists … and more

Sign up today at www.aetna.com.

Find what you need — on the go

Call us for answers

Member Services representatives are standing by to answer your questions. Just call 1-877-238-6200.

Support from our dental teamWhen you call, you get help from claims and customer service representatives who specialize in dental matters. They’ve been with us an average of 11 years. And they’ve exceeded customer service goals every month for more than 132 months.4

… and from our oral surgery specialistsThis group answers your questions about oral surgery. Plus, they help with claims that may be covered under your medical plan.

Speak another language?Customer service reps are ready. They have access to interpreters who can talk to you in over 200 languages.

Something new this year: Say good-bye to ID cards You no longer need a member ID card to get dental care. So visiting the dentist is easier than ever. But if you want a card, no problem. Once you’re a member, you can get one by logging in to the member website at www.aetna.com, using our mobile app or calling Member Services.

4Aetna Dental Customer Service Objectives. Reported from January 2003 to present.

We’re here when you need us

Apple, the Apple logo and iPhone are trademarks of Apple Inc., registered in the U.S. and other countries. App Store is a service mark of Apple Inc. Android and Google Play are trademarks of Google Inc. Other trademarks and logos displayed are the property of their respective owners.This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Aetna may receive a percentage of the fee you pay to a discount vendor. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Health and dental information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Aetna does not provide care or guarantee access to health and dental care services. Aetna does not endorse any vendor, product or service associated with discount offers. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com.Policy forms issued in Oklahoma include: GR-9/GR-9N, GR-23, GR-29/GR-29N and/or GR-96402- 02 04-09.

www.aetna.com

©2014 Aetna Inc. 00.02.335.1 G (8/14)

Enroll in any Aetna Dental benefits and insurance plan. And enjoy all the extras.