Page 5 - Carrier Assistant Benefit

Dental, Vision & Hearing Bene ts
Underwritten by Ameritas
Dental Bene t Value Standard Royal 100/70/50
Deductible
Waived on Type 1 Preventive
$25 on Type 2 Basic and Type 3 Major Per calendar year per person
Waiting Periods
None
24 months for orhtodontia only
Plan Maximum
$1,200
$1,500
Dental Rewards
Each calendar year, when you go to the dentist and the claim is submitted, and your total paid claims for the year stay at or below $750, you will earn a $250 carryover reward. This can continue until you’ve accumulated $1,000. After your plan maximum is used, the rewards kick in. Each insured has his or her own rewards bucket.
However, if you do not submit a covered dental claim during the calendar year, your accumulated rewards are reset to $0. If you do submit a claim, but exceed the $750 threshold for total paid claims, you can keep your accumulated rewards, but you will not be eligible for the $250 carryover reward.
Dental Providers
Bene ts are payable to any licensed dental provider. However, if you choose one of our Ameritas Dental Network providers, you could save 25-50% on your out-of-pocket costs. Find one near you today. Visit www.ameritas.com, Find a Provider, Dental, network provider.
Type 1 Preventative
Schedule of bene ts on the following page shows the amount insurance pays toward each covered procedure (maximum covered expense)
100%
Type 2 Basic
70%
Type 3 Major
50%
Orthodontia for child only
N/A
50% coverage after a 24-month waiting period.
$2,500 lifetime maximum per insured child.
Vision Bene t
Each calendar year, $150 can be used toward eye exams, frames, lenses, and/or contacts. If used, it will be deducted from the annual maximum bene t for dental.
Laser Vision Correction
Lifetime maximum bene t per eye per person for covered procedures. Plan will pay the lesser of the provider’s actual charge, or the bene t amount below that corresponds to the calendar year in which the covered procedure was performed.
1st Cal. Yr. 2nd Cal. Yr. 3rd Cal. Yr. 4th Cal. Yr. $0 per eye $100 per eye $250 per eye $500 per eye
N/A
Hearing Bene t
Hearing exams covered up to $75 per calendar year per person. Discounts available for hearing aids and hearing aid maintenance through an EPIC provider. For bene t questions, or to locate an EPIC provider, call 877-359-8346.
N/A
*For a listing of plan limitations and exclusions, visit www.rc-bene ts.com 4
sample