Dental PPO – Ameritas

This Ameritas PPO dental plan is a comprehensive, full service plan that covers over 360 procedures, from routine preventative to the major including crowns, dentures, and implants. Whether you need routine care or something more extensive, this plan will have you covered.

Every covered member and dependent each has a robust $1,500 in-network calendar year benefit. Coverage is available for the Association member individually, or they may also insure their spouse/domestic partner, and their dependent children up to age 26. Coverage is available to children age 26 and older if they are permanently disabled and the member lists them as a dependent on their tax return. Grandchildren are only eligible if you have full legal custody, not temporary guardianship.

This plan offers a unique Dental Rewards® benefit which provides members additional “banked funds” to use for covered procedures. Any member or dependent who use less than $750 of their annual benefit will automatically have additional funds deposited toward their calendar year maximum in future years.

As an added benefit, members who visit the dentist at least once during the year will have their Basic Services Network benefit level increased by 5% the following year - up to 85% maximum.

Ameritas has the largest dental network nationwide. There are over 325,000 providers to help ensure that you have access to quality dental care at deeply discounted prices. Ameritas has a well-earned reputation of having some of the best Network Provider discounts in the industry. Additionally, many Ameritas providers have agreed to extend deep discounts on non-covered procedures, such as cosmetic procedures like teeth whitening.

Search for Network providers in your area at: https://dentalnetwork.ameritas.com/

​Selecting the Right Dental Plan

Members have access to two different type dental plans. a PPO and an HMO. Neither plan is better or worse, they just work differently. Both are comprehensive and cover procedures from routine cleanings and X-Rays up to major issues like crowns, dentures, and implants.
PPO Plans are the most popular as they allow you to use any dentist. While they do have dentist networks, you are not required to see a dentist in the network. You are free to see any dentist. However. if you choose to use a Network Dentist, you will receive significant cost savings.
The following is an example of your cost savings with a Network Dentist, assuming a crown is $1000:
      • Your dentist is a Network Dentist: Your dentist has contracted with the insurance carrier to offer reduced fees. They agree to charge $650 instead of $1,000. Since this plan pays 70%, your out of-pocket cost is $195 (30% of the reduced $650 crown rate).
      • Your dentist is not a Network Dentist: Your dentist charges their standard rate. Insurance pays 70% based on the average local rate, frequently around $750 and you will be responsible for the remaining balance. Therefore, your out-of-pocket cost is $475 (30% of the allowable rate + 100% of the charge above the allowable rate).
We recommend selecting the PPO plan when both your current dentist does not accept the HMO plan and you're not willing to change dentists. If your dentist does accept the HMO plan or you are willing to change dentists, the HMO plan is likely the better plan for you.
HMO Plans use a network of highly qualified and pre-screened dentists. You must use one of these dentists. Referral to specialists is required and will be provided by your primary dentist.
You are never locked into a dental office. You may switch dental offices as often as you like by calling the insurance company and letting them know you wish to change.
All services are available from your first day of coverage. Unlike PPO plans, HMO plans have no calendar year maximum benefit or waiting periods. You never need to wait to receive services or worry about running out of calendar year benefits.
HMO plans have set co-pays for all covered procedures. Therefore, you will know beforehand what your out-of-pocket cost will be. Your dentist is never allowed to charge more than the agreed upon co-pays.
Plan Exclusions & Limitations are conditions that may affect how often a procedure may be done or if it is covered by the insurance. These can vary greatly between companies and plan types. For example, Ameritas allows for a crown replacement once every ten years, while Cigna allows replacement once every five years. These issues should be taken into consideration when choosing a plan.
One clause that is a standard in dental insurance policies is the Missing Tooth Clause. Insurance covers potential future events, not events that have already happened in the past. Therefore, if you have a missing tooth before the date this insurance started, the insurance will not cover an implant or bridge to replace that missing tooth.

Surgical implant Services

Description

Network Dentist
Calendar Year Benefit Maximum - All Services

This is the maximum amount the insurance carrier will pay out for your services during the calendar year. 

$1,500
Calendar Year Deductible

Waived for Preventative

$50 / Person

Preventative Services
Cleaning, Oral Exam, Bitewing X-Ray, & Fluoride.

70%

Basic Services
Filling, Simple Extraction, Periodontal Maintenance, Panoramic X-Ray, Denture Repair & Reline, Recement, Biopsy, Sealant, & Emergency Pain Relief.

70%

Major Services

A 12-month waiting period will be applied unless proof of current coverage is submitted with enrollment form.
Crown, Implant, Periodontic, Endodontic, Root Canal, Bridge, Denture, Complex Extraction, Anesthesia, Bone Augmentation, Inlay Restoration, Onlay Restoration, Crown Repair, Bridge Repair, & Space Maintainer.

70%

Surgical Implant Services.
Implant and related implant services

Note: Abutment supported crowns fall under Major Services Category.

$500

*Benefit levels are based on the average rate a dentist in your zip code would charge for that procedure.

For a complete list of covered procedures, please refer to the Certificate of Insurance.

Ameritas Dental PPO Monthly Premium
Member Only

$48
Member + Spouse / Domestic Partner or Child

$96
Member + Family

$135

*Benefit levels are based on the average rate a dentist in your zip code would charge for that procedure.

For a complete list of covered procedures, please refer to the Certificate of Insurance.

​This easy to understand, comprehensive plan covers 70% of over 360 covered procedures, from routine preventative to major, including crowns, and dentures. There is even added coverage for implants.
Each covered member and dependent receives a generous $1,500 annual benefit. This plan will pay 70% of the cost of your covered procedures, whether it is a routine cleaning or something more major like a crown or denture. This plan will also cover up to $500 for the surgical portion and components of an implant. Related components like the crown are covered under their respective category at 70%.
This plan may be used as a standalone plan or in coordination with another PPO dental plan, such as one offered by Ventura County. If used in coordination with another plan, you should have little-to-no out-of-pocket costs for covered dental procedures, even expensive procedures like crowns, dentures, and implants.
Use any dentist but using an Ameritas Network Dentist will provide you quality care at deeply discounted prices. Additionally, many Ameritas providers extend deep discounts on non-covered procedures such as teeth whitening. Finding a network provider is easy, as Ameritas has the largest dental network nationwide with over 325,000 providers.
Search for Network providers in your area at: https://dentalnetwork.ameritas.com/
Coverage is available for the member, and you may also insure your spouse/domestic partner, and/or your dependent children up to age 26. Children aged 26 and older are eligible if they are permanently disabled and the member lists them as a dependent on their tax return Grandchildren are only eligible if you have full legal custody.