Page 60 - SMS WV Overview.pdf

Comprehensive Dental Benefits

for 3-100 Eligible Employees

Dental, hearing, and LASIK coverage from Ameritas

Benefits Overview Plan A Plan B Plan C Plan D Plan E Plan F

Out of Network Maximum Allowable Benefit
Claim Allowance * MAC/MAB plans not available in AK, MA, MT or RI 90th U&C
Maximum benefit $1,000 $1,500 $2,000 $1,000 $1,500 $2,000
Per person per calendar year
Deductible Waived for Type 1
Per calendar year $50/person
$150/family
Preventive (Type 1) 100%
Basic (Type 2) 80%
Major (Type 3) 50%
Participation requirements 3-100 eligible employees (minimum of 3 enrolled)
Also included: LASIK Advantage, SoundCare, and Dental Rewards.

Child orthodontia (optional benefit with additional load)
Plan benefit 50%
Lifetime maximum per person $1,000

All plans provide access to the Ameritas Dental Network, which is one of the nation’s largest. This makes it easier for
members across the country to see the dentist of their choice.

Plans A, B & C reimburse out-of-network claims based on the Maximum Allowable Benefit (MAB) which is the lowest
contracted network provider fee in the ZIP Code area. Members who visit an out-of-network provider may have a higher
out-of-pocket expense when these plans are selected.

Plans D, E & F reimburse out-of-network claims based on the 90th Usual & Customary (U&C) allowance. We expect 9
out of 10 out of network dental charges in the ZIP Code area to be the same as, or less than, the claim allowance.

All plans provide access to the Ameritas Dental Network, which is one of the nation’s largest.
This makes it easier for members across the country to see the dentist of their choice.
• 98% of providers stay with Ameritas year after year.
• Network dentists charge 25-50% below average for their region, providing out-of-pocket
savings to members.
• The Ameritas Dental Network offers access to providers in the United States and Mexico.

Ameritas Life Insurance Corp.

GR 7778 9-21