Dental
Dalton Public Schools offers two dental plan options with Ameritas: Standard and Limited. The Standard plan has a higher premium and annual maximum and includes coverage for major services and orthodontia. The Limited plan has a lower premium with a lower annual maximum, and no coverage for major services or orthodontia. You may choose any licensed dentist for your care. However, if you obtain care from participating Ameritas dentists, you will maximize your plan benefits and keep your out-of-pocket costs as low as possible. Dependent children can be covered up to age 26 regardless of student status.
As long as you access a Classic PPO network provider, your claim will be processed at the in-network level with no balance billing. Services not covered or that exceed the calendar year maximum are the patient’s responsibility. We encourage you to use an Ameritas provider in order to maximize your dental plan benefits. Access and select the Classic (PPO) network https://dentalnetwork.ameritas.com/ to locate participating dental provider information. Refer to the Ameritas benefits summary on the Resources page for complete details regarding frequencies and coverage information.
Below is a benefit summary of your annual deductible and co-insurance costs.
| Ameritas Dental Coverage | Standard Plan | Limited Plan |
|---|---|---|
|
Deductible
|
$50 Individual | $50 Individual |
|
Preventive Services: Cleanings, exams, x-rays, and more
|
Plan pays 100% after $5 office copay | Plan pays 100% after $5 office copay |
|
Basic Services: Includes Endodontics and Periodontics
|
Plan pays 80% | Plan pays 80% |
|
Major Services: Crowns, dentures, bridges
|
Plan pays 50% | Not Covered |
|
Orthodontia: Adults and children
|
Plan pays 50% with no deductible | Not Covered |
|
Orthodontia Lifetime Maximum
|
$1,000 | Not Covered |
|
Annual Maximum (per person)
|
$1,000 | $750 |
Important Notes
-
No age limitations for coverage
-
$50 Employee deductible / $150 Family deductible (waived for preventive); differing annual maximums depending on plan
-
100% Preventive Coverage / 80% Basic Coverage / 50% Major Services (Standard Plan only) / 50% Orthodontia (Standard Plan only)
-
Members utilizing Ameritas participating dentists will enjoy discounted dental fees in addition to protection from balance billing for charges above the dentist’s maximum allowable charges. Members utilizing non-participating dentists will have the same benefits but may be subject to balance billing.
Claims Process
In-Network
- Participating Ameritas providers file the claim and accept payment from Ameritas
- Employees should not need to pay at the time of service for participating providers
Out-of-Network
- For out-of-network dentists, if the dentist does not agree to file the claim as out-of-network with Ameritas, employee pays at the time of service and files a claim for reimbursement
- The plan reimburses at the Usual and Customary (U&C) for out-of-network providers. Charges by out-of-network providers that exceed U&C are the member’s financial responsibility. (Member pays the difference between the actual charge and the plan’s U&C reimbursement level.)
Carryover Benefit
The dental plans offer a carryover benefit, allowing you to retain a portion of your unused maximum from the previous calendar year. This unused maximum is carried over and added to the upcoming year's maximum, ensuring that your benefits continue to grow.
In addition to the carryover benefit, there's a PPO Bonus. By choosing a PPO provider, members are eligible for an extra amount added to their benefits. The maximum benefit, including the carryover and PPO Bonus, is $1,000 for the Standard Plan and $500 for the Limited Plan. With our dental benefit plan, you not only receive quality care but also enjoy the financial advantages that come with the carryover benefit.
Contact Ameritas or refer to your dental plan Explanation of Benefits (EOB) for carryover benefit details.
