Dental Benefits
Predetermination of Benefits: Before treatment begins for inlays, onlays, single crowns, prosthetics, periodontics and oral surgery, you may file a dental treatment plan with Ameritas. Ameritas will provide a written response indicating benefits that may be payable for the proposed treatment.
This chart provides you a brief summary of the key benefits of the dental coverage available from Ameritas. For a complete list of all your dental coverage benefits and restrictions, please see your official plan documents.
In-Network |
Non-Network |
|
|---|---|---|
Calendar Year Deductible |
||
Individual |
$25 |
$50 |
Family Limit |
$75 |
$150 |
Waived For |
Preventive |
Preventive |
Charges Covered For You (Co-Insurance) |
||
Preventive Care |
100% |
100% |
Basic Care |
100% |
100% |
Major Care |
80% |
80% |
Orthodontia (under age 19) |
25% |
25% |
Benefit Maximum |
||
Annual Maximum Benefit |
$2,000 |
$2,000 |
Preventive Services |
Yes |
Yes |
Lifetime Orthodontia |
$1,500 |
$1,500 |
Dependent Age Limit |
26 |
26 |
Maximum Rollover |
||
To qualify for a $1,200 Maximum Rollover Account, you must have a paid claim (not just a visit) and must not have |
Cost Per Pay Period |
|
|---|---|
Employee |
$0.00 |
Employee + Spouse |
$18.52 |
Employee + Child(ren) |
$18.68 |
Family |
$38.76 |