Group Dental

You have your choice of two dental plans, the Value Plan and the Premier Plan. The Value Plan covers basic and preventive services and the Premier Plan offers these same benefits plus benefits for major services. Both plans allow you to use the dentist of your choice, cover 100% of the prevailing fees for preventive services and have a toll free phone number for prompt claims service.

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There is an annual maximum benefit of $1,000 per covered person, per policy year. With Ameritas Dental Rewards, you can increase your annual maximum benefit to $2,000! Rates are based on the area you live in and the number of eligible dependents. There is a $50 deductible, per person, per year which applies to basic and major services only.

Value Plan

Annual Maximum Benefit per covered person	$1000*
Benefit Period	Policy Year
Annual Deductible per covered person	$50.00
Deductible Accumulation Period	Policy Year

*Ameritas has Dental Rewards that allows you to earn carryover rewards towards your Annual Maximum Benefit. Your annual maximum can increase to $2,000.

Covered Expenses	Deductible Applies?	Insured Percentage	Waiting Period
Preventive Services (such as Oral Exams, Cleanings, Bitewing X-rays; also for children under age 16 – Fluoride Treatments, Sealants and Space Maintainers)	No	100%	None
Basic Services (such as Simple Extractions, Fillings, and ALL other X-rays and Minor Surgical Procedures)	Yes	80%	6 Months fillings only

Premier Plan

The Premier Plan covers the same benefits as the Value Plan and also includes the following benefits for major services.

Covered Expenses	Deductible Applies?	Insured Percentage	Waiting Period
Major Service (such as Complex Oral Surgery, Surgical Removal of Impacted Teeth, Peridontics, Root Canals, Dentures	Yes	50%	12 Months
Inlays, Crowns and Bridges*	Yes	50%	12 Months**

*Inlays, crowns and bridges are subject to the deductible and covered after a 12 month waiting period but are limited to $250 per unit.

**Stainless Steel Crowns for children under the age of 16 and treatment required directly as the result of a covered dental injury which occurs after the person’s effective date of coverage are covered at 50% with no waiting period.

This is only a summary of benefits. Definitions, restrictions and details will be provided in policy certificates.

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CA-0B80297
CA-0F08481
CA-0G14977

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