Dental Benefits

Dental insurance offers coverage for preventive care like routine exams, cleanings, and X-rays as well as basic and major services like fillings, extractions, root canals and crowns.

	Low Plan
Deductible (Indiv./Fam.) (Deductible Waived for Type 1 Services)	$50/$150
Calendar Year Benefit Max	$1,000
Type 1 - Diagnostic and Preventive Services	100%
Type 2 - Basic Services	80%
Type 3 - Major Services	N/A

Example Procedures	Low Plan
Type 1 - Diagnostic and Preventive Services	• Routine Exam (1 in 6 months) • Bite-wing X-ray (1 in 12 months) • Full Mouth/Panoramic X-rays (1 in 5 years) • Periapical X-rays • Cleaning (1 in 6 months) • Flouride for Children 13 and Under (1 in 12 months)
Type 2 - Basic Services	• Sealants (age 13 and under) • Restorative Amalgams • Restorative Composites • Endodontics (nonsurgical) • Periodontics (nonsurgical) • Denture Repair • Simple Extractions
Type 3 - Major Services	N/A

Per Pay Period Cost	Low Plan Hourly Employees	Low Plan Salary Employees
Employee Only	$10.82	$11.72
Employee + Spouse	$21.62	$23.42
Employee + Child(ren)	$27.56	$29.86
Employee + Family	$37.94	$41.40

Downloads

Low Plan Sumary

Dental insurance offers coverage for preventive care like routine exams, cleanings, and X-rays as well as basic and major services like fillings, extractions, root canals and crowns.

	In-Network
Deductible (Indiv./Fam.) (Deductible Waived for Type 1 Services)	$50/$150
Calendar Year Benefit Max	$1,500
Type 1 - Diagnostic and Preventive Services	100%
Type 2 - Basic Services	80%
Type 3 - Major Services	50%

Example Procedures	High Plan
Type 1 - Diagnostic and Preventive Services	• Routine Exam (1 in 6 months) • Bite-wing X-ray (1 in 12 months) • Full Mouth/Panoramic X-rays (1 in 3 years) • Periapical X-rays • Cleaning (1 in 6 months) • Flouride for Children 13 and Under (1 in 12 months) • Sealants (age 16 and under) • Space Maintainers
Type 2 - Basic Services	• Restorative Amalgams • Restorative Composites • Endodontics (nonsurgical) • Endodontics (surgical) • Periodontics (nonsurgical) • Periodontics (surgical) • Denture Repair • Simple Extractions • Complex Extractions • Anesthesia
Type 3 - Major Services	• Onlays • Crowns (1 in 5 years per tooth) • Crown Repair • Prosthodontics (fixed bridge; removable complete/partial dentures) (1 in 5 years)

Per Pay Period Cost	High Plan Hourly Employees	High Plan Salary Employees
Employee Only	$11.67	$12.64
Employee + Spouse	$32.68	$35.40
Employee + Child(ren)	$38.70	$41.92
Employee + Family	$55.09	$59.68

Downloads

High Plan Summary

Provided By

Ameritas

Provider Website

https://ameritas.com

Customer Service

888.487.5553

Resources

Frequently Asked Questions