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Ameritas PPO Dental
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Ameritas Dental Plan - FAQ


Ameritas Dental FAQ

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Who do I contact if I need help choosing a plan or applying?
What information do I need to apply?
Will my information be secure on your website?
Why do I need to create an Application User ID and password to apply?
How long will my Application User ID and password be valid?
What is the difference between my Application User ID and password and my secure member User ID and password?
Does My Dental Plan offer takeover benefits?
What happens after I apply for an Individual Plan?
What is the Replacement Notice?
What is the Outline of Coverage?


Are my rates guaranteed?
How often can I make premium payments?
What payment methods can I use to make premium payments?
Which credit cards do you accept for premium payment?
When should I expect to be billed for the premium if I'm paying by credit card?
What is EFT (electronic funds transfer)?
When should I expect to see the premium payment come out of my account if I'm paying by EFT?
If I want to pay by check will I receive a billing statement?
Is there a fee for paying by check?
What if I don't make my premium payment?
My coverage was terminated. When will I be eligible to reinstate coverage?


Who is eligible to purchase the plan?
When will I be covered by my policy?
When are my dependents eligible for coverage?
How long is a child considered an eligible dependent?
What is the Late Entrant limitation?
How do I obtain a copy of my dental benefits?
What is an elimination or waiting period?
Do I have coverage outside of the state I live in?
What is my ID number?
Do I need an ID card?
There's an error on my ID card. How do I get a corrected card?
Can I upgrade my plan or add more coverage?
I'mwant to cancel the policy?


How do I obtain my benefit information?
Who is authorized to obtain benefit information and claim status on my policy?
Do I need to get a pretreatment estimate for a procedure?
How many exams, cleanings and x-rays are covered?
My periodontal specialist told me I should have three or four cleanings a year, but my plan only covers two - why is this?
Is wisdom tooth removal (oral surgery) covered?
What is a missing tooth clause?
How does Dental Rewards® work?
Does individual coverage include orthodontia benefits?
Do any individual plans include vision benefits?


What is an in-network dental provider?
How do I benefit when I visit an in-network dental provider?
Can I see any dental provider or am I required to choose one from your PPO list?
How do I know if my dental provider is part of the PPO network?
My dental provider isn't on your network, but I want to take advantage of network benefits. What should I do?
Do I need a referral to see another dental provider?
What if I have a complaint about my dental provider?
Can I visit a dental provider in a foreign country?


What do I bring to my appointment?
How much will I have to pay at the time of my appointment?
Do I need to bring a claim form to my dental or vision appointment?


Who submits the claim or pretreatment estimate?
Do I have to use a certain dental or vision claim form?
How much time do I have to submit a claim?
What is your fax number for claims submission?
What is your mailing address for claims submission?
Will you send benefit payments to me or to the dental provider?


How do I check claim information?
What is an EOB (Explanation of Benefits statement)?
How do I get a copy of an EOB?
Why did you take the deductible/copayment again on my claim? I already paid it to the dental office.
Why are you paying the dental office? I already paid them.
Why did you pay me? Payment was supposed to go to the dental office.


Our Glossary
What is an annual deductible?
What is an annual maximum?
What is a waiting (elimination) period?
What is coinsurance?

Application Process
Who do I contact if I need help choosing a plan or applying?
Contact Ameritas Dental at 877-682-0282 or IndividualDentalVision@ameritas.com

What information do I need to apply?
You'll need the following information to complete the application process:
Your personal information, including your Social Security Number
Your banking information, including your account number, routing number and bank address (only applicable if you'd like payments electronically withdrawn from your account)
Your dependent's personal information, including Social Security Number(s)and date(s) of birth (only applicable if you're including coverage for dependents

Will my information be secure on your website?
The security of your information is of the utmost importance to us. Our website is SSL Secure (Secure Sockets Layer), which means all data transmitted is an encrypted link between the web server and the browser. This link ensures all data passed between the web server and browser remains private. SSL is an industry standard for web security and is used by millions of websites in the protection of online transactions.

Why do I need to create an Application User ID and password to apply?
You use your Application User ID and password to sign in and view your application information or check the status of your submitted application. You may exit the application process at any time and any information you entered will be saved. To come back later and finish your application, you'll just need to sign in with your Application User ID and password. The Application User ID and password is only valid for 60 days.

How long will my Application User ID and password be valid?
Your Application User ID and password is valid for 60 days.

What is the difference between my Application User ID and password and my secure member User ID and password?
Use your Application User ID and password during the application process to view your application or check on the status of your application. Once you're approved for coverage, you can create a secure member account at ameritasgroup.com/member. This is where you'll access benefit and claims information.

Does My Dental Plan offer takeover benefits?
If you were previously covered under a dental plan, you may be eligible for takeover benefits, which means waiting periods are waived. During the application process you will be asked to complete and submit a replacement form and provide information about your prior plan, including the date of termination. You may be required to provide an evidence of coverage letter from your prior carrier. The letter must include a termination date of the prior plan that is no more than 30 days prior to the date we receive your application for coverage. Takeover benefits apply only to MyDental Plans 1, 2 and 3.

What happens after I apply for an Individual Plan?
Once you submit a completed application for individual coverage, we begin
processing your application. Once your application is approved, you'll receive a
notification e-mail. At that time, we'll mail you your policy and ID cards. Carefully
review your policy and ID cards. Your policy will include your effective date
(the date when coverage begins).

What is the Replacement Notice?
The Replacement Notice notifies you of items to consider before replacing an existing dental plan with this dental plan. You will receive a copy of the replacement notice during the application process. Read it carefully and print a copy to save for your records.

What is the Outline of Coverage?
The Outline of Coverage is a brief description of the plan design. You will receive a copy of the Outline of Coverage when you apply for insurance - review it completely before submitting your application. For future reference, keep a
copy of the Outline of Coverage for the plan that you have selected.

Billing and Premium Payments
Are my rates guaranteed?
Your rates are guaranteed for 12 months following your plan's effective date. After that, you will receive at least 30 days notice (more if required by state law) if your rates change.

How often can I make premium payments?
When applying for coverage you can choose to make your premium payments monthly, quarterly, semi-annually or annually.

What payment methods can I use to make premium payments?
You can make premium payments by credit card, EFT (electronic funds transfer) or check. There is an $8 administrative fee applied each time you pay your premium by check.

Which credit cards do you accept for premium payment?
We accept Visa, MasterCard, American Express and Discover.

When should I expect to be billed for the premium if I'm paying by credit card?
You'll see the first billing for your premium when your application is approved. After that, the premium amount will be billed on the first business day of the month for each month of coverage. If you select quarterly, semi-annual or annual premium payments, the premium will be billed on the first business day of the selected period.

What is EFT (electronic funds transfer)?
EFT is a payment method where premium payments are automatically drafted from your checking or savings account on a regular basis. Monthly EFT payments are typically drafted on the first business day of the month.

When should I expect to see the premium payment come out of my account if I'm paying by EFT?
You'll see the first draft for your premium come out when your application is approved. After that, the premium amount will be drafted on the first business day of the month for each month of coverage. If you select quarterly, semi-annual or annual premium payments, the draft for the whole premium will come out on the first business day of the selected period.

If I want to pay by check will I receive a billing statement?
Yes, you'll receive a billing statement. Send your premium payment prior to the due date to ensure there is no lapse in your coverage.

Is there a fee for paying by check?
There is an $8 administrative fee applied each time you pay your premium by check.

What if I don't make my premium payment?
If you forget to make your premium payment and it's less than 31 days past the due date, contact us at 800-237-1276 or member@healthplan.com. If it's more than 31 days from the date the premium is due, your coverage has lapsed and will be terminated.

My coverage was terminated. When will I be eligible to reinstate coverage?
You will be eligible to reinstate 12 months from the date you last had coverage from us. You will need to reapply for coverage at that time.

Eligibility, ID Cards, Adding or Canceling Coverage
Who is eligible to purchase the plan?
The insurance coverage is available in states where it's approved to anyone age 18 and older who does not have coverage through another Ameritas dental plan. You can request coverage for your dependents; dependent eligibility varies based on state law.

When will I be covered by my policy?
You will be covered by your policy on your chosen effective date, provided your application has been approved and we've received your first premium payment. You can choose an effective date during the application process. The effective date must be the first date of one of the three months following the date your application is received by us. All effective dates are on the first day of the month.

When are my dependents eligible for coverage?
Your dependents are eligible for coverage either the day you become effective or within 31 days of becoming an eligible dependent. If applying for dependent coverage more than 31 days after your effective date, your dependent will be treated as a late entrant.

How long is a child considered an eligible dependent?
Child eligibility depends upon age and student status at the time of services. Refer to your Policy for details.

What is the Late Entrant limitation?
If you enroll dependents more than 31 days after they became eligible, they will be considered late entrants. There are benefit limitations regarding late entrants. Refer to your Policy for more details.

How do I obtain a copy of my dental benefits?
Once you've applied and been approved for coverage you will receive a Policy outlining your benefits. If you've already applied and been approved and you have not received a Policy, contact us at 800-487-5553 or group@ameritas.com.

What is an elimination or waiting period?
An elimination period or waiting period is a time period defined within the structure of some dental plans that begins on the effective date. The elimination period must be satisfied before benefits on certain procedures become available.

Do I have coverage outside of the state I live in?
Yes, if you are traveling or have a covered dependent living in a different state, you will still have coverage.

What is my ID number?
Your ID number is the policy/division/certificate number located on your ID card. You may also use your Social Security Number.

Do I need an ID card?
No, you don't need an ID card. ID cards are provided with some plans as a convenient way to present your insurance information to the dental provider. If you don't have an ID card you can give your dental office your ID number or Social Security Number. If you don't know your ID number, contact us at 800-487-5553 or group@ameritas.com.

There's an error on my ID card. How do I get a corrected card?
Contact us at 800-487-5553 or group@ameritas.com to receive an updated ID card.

Can I upgrade my plan or add more coverage?
You can only change plans at renewal. Contact us at 800-487-5553 or group@ameritas.com to discuss changing your plan.

What if I want to cancel the policy?
All cancellations must be submitted to HealthPlan Services by calling 800-237-1276 or writing PO Box 30102, Tampa, FL 33630-3264. Once the request is received, the policy will be canceled either the first day of the following month or the requested cancellation date (must be the first of a month).

Determining Benefits
How do I obtain my benefit information?
Once you're approved for coverage, sign into your secure member account at ameritasgroup.com/member to access benefit information. You can also find benefit information in your certificate or contact us at 800-487-5553 or group@ameritas.com for more detailed benefit information.

Who is authorized to obtain benefit information and claim status on my policy?
In accordance with the Health Insurance Portability and Accountability Act (HIPAA) we are required by law to maintain the privacy of our insured members' and their dependents' protected health information. If you are an insured member, the privacy law allows you to obtain benefit information and claim status on all individuals insured under your policy. If your spouse is on the policy, he or she is allowed to obtain information on dependents under the age of 18. If you'd like to authorize others to access benefit information, complete our Privacy Form and submit it to us at:
Privacy Office
PO Box 81889
Lincoln, NE 68510
Fax: 402-309-2580

Do I need to get a pretreatment estimate for a procedure?
No, you don't need to have a pretreatment estimate. However, we recommend that a pretreatment estimate be submitted for all anticipated work that you consider expensive. Pretreatment estimates are the best way for you to determine your anticipated out-of-pocket expense. For more information, visit How to Submit a Claim or Pretreatment Estimate.

How many exams, cleanings and x-rays are covered?
The frequencies of covered procedures are predetermined by your policy. To check your frequencies, sign into your secure member account at ameritasgroup.com/member or check your certificate. You can also contact us at 800-487-5553 or group@ameritas.com.

My periodontal specialist told me I should have three or four cleanings a year, but my plan only covers two - why is this?
The number of covered cleanings for each benefit period is established by the benefits and limitations/exclusions of your dental plan. We are obligated to apply the plan provisions consistently for all plan members regardless of individual circumstances. Our denial of your additional cleanings doesn't suggest that the services shouldn't be performed. We do not intervene in treatment decisions between a dental provider and patient nor do we determine dental necessity.

Is wisdom tooth removal (oral surgery) covered?
Depending upon your plan's benefits, oral surgery can fall under the Basic or Major category. Refer to your certificate for your plan benefit details. A pre-operative x-ray film is required in order to review a surgical extraction because benefits are subject to our consultant’s review. We recommend obtaining a pretreatment estimate for all dental work you consider to be expensive. This estimate helps to eliminate misunderstandings by letting you know beforehand how much the plan can cover. We also suggest submitting your oral surgery claim to your medical plan first, as some medical plans have benefits for surgical extractions and general anesthesia or IV sedation.

What is a missing tooth clause?
A missing tooth clause explains any coverage limitations related to teeth missing or extracted prior to your effective date of coverage. The missing tooth clause can vary depending upon your plan, so be sure to check your certificate of coverage for details.

How does Dental Rewards® work?
By submitting at least one dental claim each year and keeping your total benefits received for the year at or below the specified Threshold Amount, you can earn an Annual Reward that you carry over to increase your annual maximum benefit available the next year. You can accumulate rewards up to the specified Maximum Reward amount. If no dental claims are submitted during a year, no rewards are earned and any accumulated rewards are lost; the rewards balance reverts to $0. But you can begin building rewards again the very next year. Dental Rewards® is available only on MyDental Plans 1, 2 and 3.

Does individual coverage include orthodontia benefits?
No, our individual plans don't include benefits for orthodontia. However, in some states we offer discounts on non-covered procedures. Check with your provider for details.

Do any individual plans include vision benefits?
Plan 3 includes a $100 vision benefit you may use for exams, frames, lenses or contact lenses from the vision provider of your choice. You'll also receive a vision ID card that explains how to access discounts on eye exams and products. You are free to visit any vision provider you choose. However, if you visit an EyeMed provider you may benefit from additional savings on eye wear and services. If you choose to use your vision benefit, it's deducted from the total annual maximum allowed for dental benefits. If you use your plan's entire annual maximum benefit for dental care, no vision benefit will be available that year.

Choosing a Dental Provider
What is an in-network dental provider?
An in-network dental provider participates on the Ameritas dental PPO (participating provider organization) network. Ameritas plan members can choose from more than 170,000 PPO provider access points nationwide for dental care. Use our online provider directory to find an in-network dental provider.

How do I benefit when I visit an in-network dental provider?
You may benefit from greater out-of-pocket savings when you visit a dental provider on the Ameritas dental PPO network.

Can I see any dental provider or am I required to choose one from your PPO list?
You are always free to visit any dental provider you choose. However, you may benefit from greater out-of-pocket savings when you visit a dental provider on our PPO network. For a description of your plan or to find out if you have PPO access, sign into your secure member account at ameritasgroup.com/member and review your Dental Benefit Summary or certificate. If you have any questions about your choice of dental provider and how it may impact benefits, contact us at 800-487-5553 or group@ameritas.com.

How do I know if my dental provider is part of the PPO network?
Search for your dental provider in the Find a Provider directory on this website. If you have additional questions about your dental provider's status on the Ameritas PPO network, contact us at 800-487-5553 or group@ameritas.com.

My dental provider isn't on your network, but I want to take advantage of network benefits. What should I do?
You can nominate your provider to become part of our network by completing the provider nomination form. Please understand that nominating a provider doesn't guarantee they will become an active participant in the Ameritas PPO network.

Do I need a referral to see another dental provider?
No. You are welcome to seek treatment from any dental provider. If you have PPO coverage, we suggest using an Ameritas PPO dental provider to help maximize your benefits and lower your out-of-pocket expenses.

What if I have a complaint about my dental provider?
If you have concerns about the experience you have had with a participating provider, contact us at 800-487-5553 or group@ameritas.com.

Can I visit a dental provider in a foreign country?
Yes, however we only honor assignment of benefits to providers in the United States. Since services provided outside the United States must be reimbursed directly to the member, foreign-based providers typically require payment in full before services are completed. We do not have a PPO network outside the United States.

The Appointment
What do I bring to my appointment?
If you have an ID card, take it with you. If you don't have an ID card, give the dental office your ID number or Social Security Number. If you don't know your ID number, contact us at 800-487-5553 or group@ameritas.com. You might also consider taking your certificate or a copy of your Dental Benefit Summary. To access either, sign into your secure member account at ameritasgroup.com/member.

How much will I have to pay at the time of my appointment?
You will be responsible for your deductible and coinsurance. However, some dental offices will not collect the deductible or coinsurance until after the claim has been processed by insurance. Contact your dental office to ask how they do their billing.

Do I need to bring a claim form to my dental or vision appointment?
In most instances you do not need to bring a claim form with you. If the provider office submits insurance claims for you, they already have claim forms. However, if the office requires that you file your own claim(s) with insurance, please make sure the provider or specialist gives you a statement. Complete only the top portion (Part 1) of a Dental Claim Form or Vision Claim Form with the patient and member information, attach a copy of the provider's statement and submit to us at:
Ameritas Claims Department
PO Box 82520
Lincoln, NE 68501-2520
Fax: 402-467-7336

Claims Submission
Who submits the claim or pretreatment estimate?
If your plan has the PPO option and you go to a dental provider who is on the Ameritas PPO network, the dental provider will submit claims and pretreatment estimates for you. However, if you see a non-participating dental provider you'll need to contact your dental office and ask if they will submit claims or pretreatment estimates for you.

Do I have to use a certain dental or vision claim form?
No. You are not required to use our claim form. You may use any standard dental or vision claim form.
Dental Claim Form
Vision Claim Form

How much time do I have to submit a claim?
We recommend that claims be submitted as soon as possible, as dental plans have a timely filing clause. Unless otherwise noted in your certificate, active insured members must submit claims to us within 90 days of the date of service. Claims submitted after 90 days will be denied due to failure to meet the timely filing requirements.

What is your fax number for claims submission?
Claims that don't require x-ray films may be faxed to 402-467-7336.

What is your mailing address for claims submission?
Ameritas Claims Department
PO Box 82520
Lincoln, NE 68501-2520

Will you send benefit payments to me or to the dental provider?
If services are performed in the United States, we'll assign benefits according to how they are authorized on the claim form. If services are performed outside the United States, benefits will automatically be assigned to the insured member. If you visit a PPO dental provider, benefit payments are automatically issued directly to the provider based on their contractual agreement. For nonparticipating providers, benefits can be assigned to the insured member or to the provider. If you'd like the benefits assigned to you, please leave the authorization line blank on the claim form.

What information do you need for my student-dependent?
Please contact us at 800-487-5553 or group@ameritas.com for the most current information.

Understanding Payment and EOBs (Explanation of Benefits statements)
How do I check claim information?
To access claim information online, sign into your secure member account at ameritasgroup.com/member. Contact us at 800-487-5553 or group@ameritas.com if you have additional claim questions.

What is an EOB (Explanation of Benefits statement)?
An EOB is a statement that summarizes the processing of a claim. The statement includes date of service, services performed, provider identification, a summary of charges and explanations of payment or denial. It is also called a Benefit Statement or Claim Explanation.

How do I get a copy of an EOB?
Sign into your secure member account at ameritasgroup.com/member and choose Claim Information. You may also contact us at 800-487-5553 or group@ameritas.com for a copy of your EOB.

Why did you take the deductible/copayment again on my claim? I already paid it to the dental office.
In most cases we are not collecting the deductible/copayment twice (once by us and once by the dental office). If the dental provider collected the deductible/copayment from you, we note the deductible/copayment for our records and this is reflected on your EOB. If you feel an error has been made on your EOB, contact us at 800-487-5553 or group@ameritas.com.

Why are you paying the dental office? I already paid them.
We pay according to how benefits are authorized on the claim form. If you sign the authorization field on the claim form, benefit payment is released to the dental office and we will pay benefits to your dental office. If your plan has the PPO option and you visit a participating dental provider, benefits will be assigned to them per their contractual agreement. If you are being charged up front for the full amount of your services by a participating dental provider, contact us at 800-487-5553 or group@ameritas.com.

Why did you pay me? Payment was supposed to go to the dental office.
Ameritas pays according to how benefits are authorized on the claim form. If you sign the authorization field on the claim form, benefit payment is released to the dental office and we will pay benefits to your dental office.

Common Terms
Visit
our glossary for a complete list of insurance and dental health terms.

What is an annual deductible?
An annual deductible is a specified amount of eligible expenses that must be incurred and paid by the insured member prior to any benefits being paid. Ineligible or non-covered expenses do not count toward  satisfaction of a deductible. An annual deductible is deducted yearly on the plan's benefit period.

What is an annual maximum?
An annual maximum is the maximum dollar amount a dental plan will pay toward the cost of dental care incurred by an individual or family in a calendar year.

What is a waiting (elimination) period?
A waiting period is a period of time a person must be enrolled in a plan before qualifying for benefits.

What is coinsurance?
Coinsurance is an arrangement that assigns expenses between you and the insurer. You share in the cost of covered services on a percentage basis.