Ameritas
If you’re looking for an individual dental PPO plan that offer similar benefits to a group dental plan, an Ameritas Dental Plan is for you. It provides coverage for everything an employer plan would – preventive care coverage for cleanings and X-rays, crowns, bridges, and fillings.
Although you can see any dentist you choose, you will receive the maximum plan benefits for using an Ameritas dental provider. If you visit a non-network dental provider, the plans reimburse at the 90th percentile of usual & customary prices. This means that 9 out of 10 dentists in a given zip code do not charge more than Ameritas’ reimbursement amount, a very rare and generous benefit that minimizes or eliminates balance billing.
Plan highlights include:
- No waiting periods — start using your plan immediately!
- Simple & affordable — plans start at less than $30/month
- Take advantage of the PPO network — plans are accepted by over 400,000 dental locations nationwide.
- Easy enrollment — picking and enrolling in a plan takes less than 5 minutes!
- Freedom to use any dentist
- 100% coverage for preventive services
- Available for all ages including seniors over 65
- Choice of 3 plan options — with an annual maximum benefit of $2,000
- Dental Rewards included in all plans – increase your annual maximum by submitting at least one dental claim per year and keeping your total paid claims for the year at or below the Threshold Amount: $250 for Plans 1 and 2; $500 for Plan 3. You will “earn” an Annual Reward – $125 for Plans 1 and 2; $250 for Plan 3 – to carry over toward your annual maximum benefit the next year.
2023 Plan Comparison
| Benefit Highlight | Ameritas Plan 1 | Ameritas Plan 2 | Ameritas Plan 3 |
|---|---|---|---|
| Calendar Year Maximum | $1,000 | $1,500 | $2,000 |
| Annual Deductible | All plans require that you pay a $50 annual dental deductible per person before receiving any benefits. | ||
| Routine Exams with Cleaning Covered Per Calendar Year | 1 | 1 | 2 |
Preventive Services
| 100% | 100% | 100% |
| Basic Services
| 80% | 80% | 80% |
| Major Services
| Not covered | 50% | 50% |
| How Coinsurance Works | Network Provider
When you visit an Ameritas PPO Network Dentist, payment is sent directly to the dentist and the amount allowed for each covered procedure is based on the Maximum Allowable Charge. The Maximum Allowable Charge is the network provider’s contracted fee, derived and discounted from the array of provider charges within a particular ZIP Code area. It is reviewed and updated periodically to reflect increasing provider fees within the ZIP Code area. You pay the difference between the plan payment and the network dentist’s contracted fee. Non-Network Provider When you visit a dentist who is not in the Ameritas PPO network, the amount allowed for each covered procedure is based on the Maximum Allowable Benefit. The Maximum Allowable Benefit is derived from a blending and discounting of submitted provider charges within a particular ZIP Code area. It is reviewed and updated periodically to reflect increasing provider fees within the ZIP Code area. You pay the difference between the plan payment and the dentist’s actual charge. | ||
| Waiting (Elimination) Period | 6 Months for Type 2 Benefits | 6 Months for Type 2, 6 Months for Type 3 Benefits | 6 Months for Type 2, 6 Months for Type 3 Benefits |
| Waiting (Elimination) Period will be waived if you qualify for Takeover. If you were previously covered under a dental plan, you may be eligible for takeover benefits, which means waiting periods are waived. You will be asked to complete and submit a replacement form, plus provide an evidence of coverage letter from your prior carrier, which must include a termination date of the prior plan that is no more than 30 days prior to the date we receive your application for My Dental Plan coverage. | |||
| Dental Rewards | All plans offer Dental Rewards to enhance the value of your annual maximum benefit.
Boost your annual maximum by submitting at least one dental claim per year and keeping your total paid claims for the year at or below the Threshold Amount: $250 for Plans 1 and 2; $500 for Plan 3. You will “earn” an Annual Reward – $125 for Plans 1 and 2; $250 for Plan 3 – to carry over toward your annual maximum benefit the next year. Accumulate rewards each year up to the total Maximum Reward Amount: $500 for Plans 1 and 2; $1,000 for Plan 3. Where PPO is available, there’s also a $50 bonus to carry over if you see an Ameritas PPO provider. If no claims are submitted during a year, no rewards are earned and accumulated rewards are lost. But you can begin building rewards again the very next year. | ||
| Vision Benefit | None* | None* | $100 |
| A $100 benefit that you may use for exams, frames, lenses or contact lenses from the eye care provider of your choice. In addition, if you enroll in Plan 3, you will receive an eye care ID card that explains how to access eye care discounts. If you choose to use your eye care benefit, it is deducted from the total annual maximum allowed for dental benefits. If you use your plan’s entire annual maximum benefit for dental care, no eye care benefit will be available that year.
*Members may receive a savings on eyewear frames and lenses purchased at any Walmart Vision Center nationwide. | |||
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