Ameritas Life of NY
Dallas Smile Plan
- As long as you meet the plan's general eligibility requirements and pay the applicable premium, your acceptance is automatic
- You can also include all eligible children under your guardianship
- The Dallas Smile Plan is a PPO plan
- The Dallas Smile Plan helps pay the cost of most dental care services, including exams, cleanings, fillings, extractions, crowns, bridges, dentures and implants
- Money-saving Preventive Plus benefit offered with this plan - Type 1 Preventive procedures are not deducted from the plan's annual maximum benefit. This saves all of the annual benefit to help pay for more expensive Type 2 (Basic) and 3 (Major) procedures.
- Apply online for your convenience and have the cost of insurance automatically deducted from your checking or savings account. That way you will have no extra checks to write and no new due dates to remember
| Common procedures: | |
|---|---|
| Cleaning: | 100% |
| White Filling: | 50-80% |
| Crown: | 50% |
| Root Canals: | 50% |
| Simple Extractions: | 50% |
| Plan Maximum: | $1500 per benefit year, per insured person Preventive Plus Benefit – Type 1 Preventive procedures are not deducted from the plan's annual maximum benefit |
| Waiting Periods: | Preventive, Basic – None, Major – 12 months |
| Deductible: | $100 Benefit year Deductible per insured person for Basic and Major Services (a maximum of 3 deductibles per family) |
| Details: |
|---|
| Fee Schedule: N/A | Dentist Search | Exams: |
| Routine periodic examinations - 2 in a benefit year 100% Preventive – No waiting period | Cleanings: |
| Teeth Cleanings – 3 in a benefit year 100% Preventive – No waiting period | X-Rays: |
| Radiography: X-rays 1st year – 50% after deductible 2nd year and after – 80% after deductible Basic – No waiting period | Fillings: |
| Restorative Amalgam Fillings. Resin–based composite (white fillings) anterior only 1st year – 50% after deductible 2nd year and after – 80% after deductible Basic – No waiting period | Extractions: |
| Simple Extractions and Oral Surgery 50% after deductible Major – 12 months waiting period | Crowns: |
| 50% after deductible Major – 12 months waiting period | Root Canals: |
| Endodontics: Pulpal therapy and root canals 50% after deductible Major – 12 months waiting period | Dentures: |
| 50% after deductible Major – 12 months waiting period | Deep Cleanings: |
| Treatment of diseases of the gums 50% after deductible Major – 12 months waiting period | Implants: |
| 50% after deductible Major – 12 months waiting period | Braces/Orthodontia: |
| Not Covered Service | Teeth Whitening: |
| Not Covered Service | Additional Network Information: |
The Ameritas Dental Network is one of the nation’s largest. Network providers have agreed to charge 25-50% less than their regular rates which can lower your out-of-pocket costs. The Maximum Allowable Charge (MAC) claim allowance is the maximum amount a network provider may charge. If you select a network provider, you may have lower out-of-pocket costs. If you visit an out-of-network dentist, the claim allowance is considered at the Maximum Allowable Benefit (MAB), which is equal to the lowest contracted fee in your ZIP Code. Any difference between the plan allowance and the dentist’s charge will be an out-of-pocket expense for you. You can visit any dentist, in- or out-of-network. And family members do not need to visit the same provider. Find a dental provider near you. PPO Plans not available in all states. Exclusions and LimitationsPrivacy Policy: N/A Plan Brochure: N/A |
FAQ:
Can I change my dentist once I am in the plan?
Yes, you may change your dentist at any time.
What is a pre-existing condition versus work-in-progress? Is it covered?
A pre-existing condition is an oral health condition, which existed before your enrollment in a dental program.
Work in progress is any oral health procedure that is started and not completed prior to your enrollment in a dental program.
See your plan documentation for pre-existing conditions exclusions. The plan does not cover any expenses prior to the date you are covered under the Policy.
What provider options do I have?
The Ameritas Dental Network is one of the nation’s largest. Network providers have agreed to charge 25-50% less than their regular rates which can lower your out-of-pocket costs.
The Maximum Allowable Charge (MAC) claim allowance is the maximum amount a network provider may charge. If you select a network provider, you may have lower out-of-pocket costs.
If you visit an out-of-network dentist, the claim allowance is considered at the Maximum Allowable Benefit (MAB), which is equal to the lowest contracted fee in your ZIP Code. In states of AK, GA, MA, MS, NJ and LA, out-of-network coverage considered at 80th percentile of UCR. Any difference between the plan allowance and the dentist’s charge will be an out-of-pocket expense for you.
You can visit any dentist, in- or out-of-network. And family members do not need to visit the same provider.
Find a dental provider near you.
PPO Plans not available in all states.
When can I start using my Plan?
You can start using your plan once it goes into effect. You can pick a date as soon as day after tomorrow, or up to 3 months from today. Incomplete enrollment forms or failure to submit the required initial premium amount may cause an initial delay in issuance of insurance. Do not cancel any other insurance or assume you are insured under the Plan until you receive your certificate of insurance.
Note: Applicants and dependents cannot have duplicate policies underwritten by Ameritas, or any brand that is underwritten by Ameritas (i.e. two dental or two vision plans).
When will I receive my new member kit and what will it include?
You will receive your enrollment package within 10-14 days of submission of your application. Your enrollment package will include a welcome letter, insurance documents and ID card.
Who can enroll in this plan?
Individuals who are 18 years of age and older, and their eligible dependents (unmarried children from birth to age 26) are eligible to apply for coverage. Eligible ages for dependents may vary by state. Dependents named in the application must be approved by Ameritas Life Insurance Corp. as eligible. Specific criteria for dependent eligibility may vary by state.
As long as you meet the plan’s general eligibility requirements and pay the applicable premium, your acceptance is automatic.
1350 Broadway Suite 1710
New York, NY 10018
Disclaimers and Disclosures:
Ameritas Life Insurance Corp. of New York:
Underwritten by Ameritas Life Insurance Corp. of New York | 1350 Broadway Suite 1710 New York, NY 10018
This is not a certificate of insurance or guarantee of coverage. Plan designs may not be available in all areas and are subject to individual state regulations. This information is provided by Ameritas Life Insurance Corp. of New York (Ameritas of New York). Dental and vision products (9000 NY Rev. 03-15 for Group and 9000 NY Rev. 03-18 for Individual) are issued by Ameritas of New York. Ameritas, the bison design and “fulfilling life” are service marks or registered service marks of Ameritas Life, affiliate Ameritas Holding Company or Ameritas Mutual Holding Company. © 2023 Ameritas Mutual Holding Company.
This website provides a very brief description of some of the important features of this plan. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exclusions and limitations is contained in the Schedule of Benefits and your policy.
Rates shown are based upon the information you provided, and are subject to change based on the dental and/or vision plan's underwriting practices and your selection of available optional benefits, if any. Final rates and effective dates are subject to underwriting and are always determined by the dental insurance and/or vision insurance company. To be considered for reimbursement, expenses must qualify as covered expenses.
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