Page 6 - Goddard School of Owings Mills

Excellence in Owings Mills, Inc
Dental Highlight Sheet

Plan 1: Dental Plan Summary Effective Date: 1/1/2025
Plan Benefit
Type 1 100%
Type 2 80%
Type 3 50%
Deductible $50/Calendar Year Type 2 & 3
Waived Type 1
$150/family
Maximum (per person) $2,000 per calendar year
Allowance Discounted Fee
Dental Rewards® Included
Waiting Period None
Annual Eye Exam None
LASIK Advantage® Included
Annual Open Enrollment Included

Sample Procedure Listing (Current Dental Terminology © American Dental Association.)
Type 1 Type 2 Type 3
z Routine Exam z Fillings for Cavities z Onlays
(2 per benefit period) z Restorative Composites z Crowns
z Bitewing X-rays z Endodontics (nonsurgical) (1 in 8 years per tooth)
(1 per benefit period) z Simple Extractions z Crown Repair
z Full Mouth/Panoramic X-rays z Endodontics (surgical)
(1 in 5 years) z Periodontics (nonsurgical)
z Periapical X-rays z Periodontics (surgical)
z Cleaning z Denture Repair
(2 per benefit period) z Prosthodontics (fixed bridge; removable
z Fluoride for Children 18 and under complete/partial dentures)
(1 per benefit period) (1 in 8 years)
z Sealants (age 18 and under) z Complex Extractions
z Space Maintainers z Anesthesia
Monthly Rates
Employee Only (EE) $34.64
EE + Spouse $69.28
EE + Children $81.12
EE + Spouse & Children $115.72

Ameritas Information
We're Here to Help
This plan was designed specifically for the associates of Excellence in Owings Mills, Inc. At Ameritas Group, we do more than
provide coverage - we make sure there's always a friendly voice to explain your benefits, listen to your concerns, and answer your
questions. Our customer relations associates will be pleased to assist you 7 a.m. to midnight (Central Time) Monday through
Thursday, and 7 a.m. to 6:30 p.m. on Friday. You can speak to them by calling toll-free: 800-487-5553. For plan information any time,
access our automated voice response system or go online to ameritas.com.