Plan Information


PPO Fee Schedule

The Ameritas Network features:

  • Discounted fees, typically 30% below average charges in your community
  • Immediate network discounts
  • One of the largest nationwide networks with over 400,000 access points and 100,000 unique providers

If you visit an Ameritas dental network provider, the plan-paid benefits are based on a contracted fee schedule.

Hollywood Smile 2000 plan is designed for those who will visit an Ameritas dental network provider. If you visit an in-network provider, your out-of-pocket costs will almost always be less because of the contracted fees (MAC/maximum allowable charge). If you visit an out-of-network dentist, you pay the difference between what the plan pays and the dentist’s actual charge (MAB/maximum allowable benefit), which may result in higher out-of-pocket costs.

PPO Plans not available in all states.

PPO Fee Schedule
  Year One Year Two Year Three
  Plan Pays:
In Network
(Out of Network)
Preventive Dental Benefits (type 1) Routine exams, teeth cleanings, topical fluoride (children under age 16).
No waiting period.
Plan Pays 80%
(50%)
Plan Pays 90%
(60%)
Plan Pays 100%
(70%)
Basic Dental Benefits (type 2) X-rays, fillings.
No waiting period.
Plan Pays 50%
(30%)
Plan Pays 60%
(40%)
Plan Pays 80%
(50%)
Major Dental Benefits (type 3) Simple extractions, oral surgeries, periodontics, endodontics, crowns, bridges, dentures.
No waiting period.
Plan Pays 20%
(10%)
Plan Pays 40%
(20%)
Plan Pays 50%
(30%)
Combined Calendar Year Deductible for Preventive (type 1), Basic (type 2) and Major Services (type 3) $100 per insured person
(a maximum of 3 deductibles per family)
Maximum Benefit Amount Per calendar year, per insured person $2,000
Major Services Maximum Per calendar year, per insured person. $1,000

 

Underwritten by Ameritas Life Insurance Corp. This provides a very brief description of some of the important features of this insurance policy. It is not the insurance policy and does not represent it. A full explanation of benefits, exceptions and limitations is contained in the Individual Dental Policy Form Indiv. 9000 Rev. 07-16 and/or Vision Policy Form Indiv. 9000 Ed. 07-16-V. Premium rates may change upon renewal. This policy is renewable at the option of the insured. This product may not be available in all states and is subject to individual state regulations.

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