Aetna corrects dental-insurance policy

Published: April 14, 2009

Last updated on July 20th, 2016

Aetna has corrected the coordination-of-benefits policy of the national dental plan it administers for UTU members employed on freight railroads and Amtrak. The change applies only where Aetna is the secondary payer and the primary payer is another dental-insurance plan.

An audit of the national dental plan late last year revealed that Aetna was administering the coordination-of-benefits (COB) provision incorrectly when it was the secondary payer and the primary payer was another plan.

As a result, effective Jan. 1, 2009, Aetna began applying the COB provisions as spelled out in the summary plan description.

Before the error was discovered, Aetna had been paying 100 percent of its reasonable and customary rate, minus the amount paid by the primary policy. The correct method is for Aetna to pay the difference, if any, between the primary plan’s benefit and what Aetna would have paid had it had been the primary insurer.

If the Aetna benefit is the same or less than the primary plan’s benefit, Aetna pays nothing, as provided for in the summary plan description.

This change does not apply where a husband and wife are both covered by the national dental plan.