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Ameritas
Hollywood Smile Premier Plus 2000

  • 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 Hollywood Smile Premier Plus 2000 Plan is a PPO plan
  • The Hollywood Smile Premier Plus 2000 Plan helps pay the cost of most dental care services, including exams, cleanings, fillings, extractions, crowns, bridges and dentures
  • 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. Preventive Plus Benefit - not available in FL
  • Hearing benefit available with this plan
  • 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:20-50%
Root Canals:20-50%
Simple Extractions:20-50%
Plan Maximum:$2000 per benefit year, per insured person
$1000 per benefit year, per insured person for Major Services
Preventive Plus Benefit – Type 1 Preventive procedures are not deducted from the plan's annual maximum benefit. Preventive Plus Benefit - not available in FL
Waiting Periods:None
Deductible:$100 benefit year deductible per insured person (a maximum of 3 deductibles per family)
Details:
Fee Schedule: N/A  |  Dentist Search
Exams:
Routine periodic examinations twice in a benefit year
100% after deductible
Preventive – No waiting period
Cleanings:
Teeth Cleanings – three in a benefit year
100% after deductible
Preventive – No waiting period
X-Rays:
Radiography: Bitewing and full-mouth x–rays
1st year – 50% after deductible
2nd year – 60% after deductible
3rd 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 – 60% after deductible
3rd year and after – 80% after deductible
Basic – No waiting period
Extractions:
Extractions and other oral surgery, including pre– and post–operative care
1st year – 20% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Major – No waiting period
Crowns:
1st year – 20% after deductible
2nd year – 30 % after deductible
3rd year and after – 50% after deductible
Major – No waiting period
Root Canals:
Endodontics: Pulpal therapy and root canals
1st year – 20% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Major – No waiting period
Dentures:
1st year – 20% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Major – No waiting period
Deep Cleanings:
Treatment of diseases of the gums
1st year – 20% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Major – No waiting period
Implants:
Not Covered Service
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 Limitations
Privacy Policy: N/A
Plan Brochure: N/A
Notes:

Hearing Benefit Included: $75 Exam + Materials Benefit Maximum: $200 year 1, $300 year 2, $400 year 3
Benefits are available for hearing exams and hearing aids. Each benefit period you receive up to $75 for eligible hearing exams. The plan pays 50% of the hearing aid cost up to the maximum benefit. The maximum benefit is $200 day 1, $300 after year 1, and $400 after year 2.
Five years after using your hearing aid coverage, you are re-eligible for the benefit at the top level. A reduced benefit is available after three years if your current hearing aids can no longer correct your hearing. All benefits assume no break in coverage.
Hearing Benefit - not available in states of MA, NH, and NM


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 - usually the 1st of the month following your enrollment (as long as the enrollment and payment is received within the enrollment deadline). 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.

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.

Ameritas Life Insurance Corp.
P.O.Box 81889
Lincoln, NE 68501

Disclaimers and Disclosures:

Ameritas Life Insurance Corp.:

Underwritten by Ameritas Life Insurance Corp. | 5900 O Street Lincoln, NE 68510

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 piece is not for use in New Mexico. This information is provided by Ameritas Life Insurance Corp. (Ameritas Life). Dental, vision and hearing care products (9000 Rev. 03-16 for Group and 9000 Rev. 02-19 for Individual, dates may vary by state) are issued by Ameritas Life. The Dental and Vision Networks are not available in RI. In Texas, our dental network and plans are referred to as the Ameritas Dental Network. 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. © 2021 Ameritas Mutual Holding Company.

Hearing is not available in the states of NH, NM and MA.

New Mexico:

Underwritten by Ameritas Life Insurance Corp. | 5900 O Street Lincoln, NE 68510

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. (Ameritas Life). Dental and vision products (9000 NM Rev. 06-17 for Group and Indiv. 9000 NM Rev. 02-19 for Individual) are issued by Ameritas Life. 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. © 2021 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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