- Keep your dentist or choose an In-Network dentist and save
- Over 400,000 providers to choose from, whether home or away
- No waiting period on covered services – get access right away
- Covers exams, cleanings, fillings, crowns, implants, and more
- High annual maximum
that can increase after one year
Member
$45.85/month
$58.71/month
Member +1
$87.12/month
$113.84/month
Member +Family
$137.86/month
$191.13/month
Deductible
$10.00 per visit/person
$50.00
per year/person
(waived for Preventative services)
In Network
$1,250.00 per year/person
$1,500.00 per year/person
Out of Network
$1,250.00 per year/person
$1,500.00 per year/person
Annual Benefit Threshold
$500.00
$750.00
Annual Maximum Benefit
$1,250.00
$1,500.00
Dental Rewards Carry Over
$250.00
$250.00
Year 2 Maximum Benefit
$1,500.00
$1,750.00
Total Maximum Benefit
$2,250.00
$2,500.00
Preventative
X-Rays
M.C.E. $40 (bitewing 4 image)
M.C.E. $77 (panoramic)
Covers 100% (bitewing)
Covers 80% (panoramic)
Routine Cleanings
M.C.E. $61
Covers 100%
Routine Oral Exams
M.C.E. $29
Covers 100%
Basic
Denture Repair
M.C.E. $80 (maxillary)
Covers 80%
Fillings
M.C.E. $82 (2 surface amalgam)
M.C.E. $100 (2 surface resin)
Covers 80%
X-Rays
M.C.E. $40 (bitewing 4 image)
M.C.E. $77 (panoramic)
Covers 100% (bitewing)
Covers 80% (panoramic)
Major
Crown
M.C.E. $368 (full cast noble metal)
Covers 50% (all types)
Dentures
M.C.E. $453 (maxillary)
Covers 50% (all types)
Extractions
M.C.E. $46 (simple)
Covers 50% (simple and complex)
General Anesthesia
M.C.E. $136
Covers 50%
Implants
M.C.E. $1238
Covers 50%
Root Canal
M.C.E. $300 (premolar tooth)
Covers 50% (all types)
Crown Repair
Not Covered
Covers 50%
Periodontics
Not Covered
Covers 50%
Use your current dentist OR Save 25-50% with a dentist in our network.
Find a dentist
(note: Enter zip, select city & state, and Classic PPO network.)
Details may vary based on start date. Please note it may take 10-15 days to process your enrollment. You will receive a ‘welcome to the program’ letter which will include your group number and carrier details. Please consult your policy as the final ultimate source of covered services and program details.
Rates valid from 1 October, 2020 to 30 September, 2024.
{
"services": {
"X-Rays": {
"Gold": "M.C.E. $40 (bitewing 4 image)<\/span>
M.C.E. $77 (panoramic)<\/span>",
"Platinum": "Covers 100% (bitewing)<\/span>
Covers 80% (panoramic)<\/span>"
},
"Routine Cleanings": {
"Gold": "M.C.E. $61",
"Platinum": "Covers 100%"
},
"Routine Oral Exams": {
"Gold": "M.C.E. $29",
"Platinum": "Covers 100%"
},
"Denture Repair": {
"Gold": "M.C.E. $80 (maxillary)<\/span>",
"Platinum": "Covers 80%"
},
"Fillings": {
"Gold": "M.C.E. $82 (2 surface amalgam)<\/span>
M.C.E. $100 (2 surface resin)<\/span>",
"Platinum": "Covers 80%"
},
"Crown": {
"Gold": "M.C.E. $368 (full cast noble metal)<\/span>",
"Platinum": "Covers 50% (all types)<\/span>"
},
"Dentures": {
"Gold": "M.C.E. $453 (maxillary)<\/span>",
"Platinum": "Covers 50% (all types)<\/span>"
},
"Extractions": {
"Gold": "M.C.E. $46 (simple)<\/span>",
"Platinum": "Covers 50% (simple and complex)<\/span>"
},
"General Anesthesia": {
"Gold": "M.C.E. $136",
"Platinum": "Covers 50%"
},
"Implants": {
"Gold": "M.C.E. $1238",
"Platinum": "Covers 50%"
},
"Root Canal": {
"Gold": "M.C.E. $300 (premolar tooth)<\/span>",
"Platinum": "Covers 50% (all types)<\/span>"
},
"Crown Repair": {
"Platinum": "Covers 50%"
},
"Periodontics": {
"Platinum": "Covers 50%"
}
},
"plans": {
"Gold": {
"inEffect": "2020-10-01T00:00:00",
"marketingInEffect": "2020-10-01T00:00:00",
"outOfEffect": "2024-09-30T00:00:00",
"marketingOutOfEffect": "2024-09-30T00:00:00",
"policyNumber": "350970",
"cleaningsPerPeriod": 2,
"cleaningPeriod": "Benefit Period",
"orthoEliminationPeriod": 0,
"examFrequency": 2,
"examPeriod": "Benefit Period",
"orthoCoverageDescription": "None",
"orthoLifetimeMax": 0,
"orthoCoInsurance": 0,
"annualPlanMax": 1250,
"outOfNetAnnualPlanMax": 1250,
"rewardsThreshold": 500,
"rewardsAnnualRollover": 250,
"ppobonus": 150,
"rewardsMaxRollover": 1000,
"waitingPeriod": null,
"notes": null,
"deductible": 10,
"familyDeductibleMax": 0,
"dentalRewards": true,
"planLevel": "Gold",
"dentalNetworkDescription": "Non-PPO \/ Out-Of-Network Benefits",
"frequencyType": "Per Visit",
"carrier": {
"fullName": "Ameritas Life Insurance Corp",
"shortName": "Ameritas",
"logo": "\/img\/ameritas.png",
"creativeApproval": "2020-03-11T19:51:51.743",
"legalName": "Ameritas Life Insurance Corp (Ameritas Life)",
"website": "https:\/\/dentalnetwork.ameritas.com\/",
"phone": "1-877-983-3582",
"instructions": "Enter zip, select city & state, and Classic PPO network."
},
"dentalPlanCoverage": [
{
"rate": 45.85,
"coverage": "Member"
},
{
"rate": 87.12,
"coverage": "Member +1"
},
{
"rate": 137.86,
"coverage": "Member +Family"
}
],
"dentalPlanType": [
{
"dentalType": null,
"inNetworkPercent": 0,
"outOfNetworkPercent": 0,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"frequency": 0,
"mceamount": 40,
"frequencyType": null,
"name": "Bitewing X-rays (4 image)"
},
{
"frequency": 0,
"mceamount": 61,
"frequencyType": null,
"name": "Routine Cleanings"
},
{
"frequency": 0,
"mceamount": 29,
"frequencyType": null,
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}
]
},
{
"dentalType": null,
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"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"frequency": 0,
"mceamount": 80,
"frequencyType": null,
"name": "Denture Repair (maxillary)"
},
{
"frequency": 0,
"mceamount": 82,
"frequencyType": null,
"name": "Fillings (2 surface amalgam)"
},
{
"frequency": 0,
"mceamount": 100,
"frequencyType": null,
"name": "Fillings (2 surface resin)"
},
{
"frequency": 0,
"mceamount": 77,
"frequencyType": null,
"name": "Panoramic X-Rays"
}
]
},
{
"dentalType": null,
"inNetworkPercent": 0,
"outOfNetworkPercent": 0,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
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{
"frequency": 0,
"mceamount": 368,
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"name": "Crown (full cast noble metal)"
},
{
"frequency": 0,
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"frequencyType": null,
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},
{
"frequency": 0,
"mceamount": 46,
"frequencyType": null,
"name": "Extraction (simple)"
},
{
"frequency": 0,
"mceamount": 136,
"frequencyType": null,
"name": "General Anesthesia"
},
{
"frequency": 0,
"mceamount": 1238,
"frequencyType": null,
"name": "Implants"
},
{
"frequency": 0,
"mceamount": 300,
"frequencyType": null,
"name": "Root Canal (premolar tooth)"
}
]
}
],
"inEffectDate": "2020-10-01",
"inEffectTimestamp": 1601510400,
"outOfEffectDate": "2024-09-30",
"outOfEffectTimestamp": 1727654400,
"marketingInEffectDate": "2020-10-01",
"marketingInEffectTimestamp": 1601510400,
"inEffectDateCalc": "2020-10-01",
"marketingOutOfEffectDate": "2024-09-30",
"marketingOutOfEffectTimestamp": 1727654400,
"planLevelText": "Essential Coverage",
"frequencyText": "per visit & per person",
"frequencyTextAlt": "per visit\/person",
"planCoverage": [
{
"rate": 45.85,
"coverage": "Member"
},
{
"rate": 87.12,
"coverage": "Member +1"
},
{
"rate": 137.86,
"coverage": "Member +Family"
}
],
"planType": "dental",
"types": [
{
"dentalType": null,
"inNetworkPercent": 0,
"outOfNetworkPercent": 0,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"frequency": 0,
"mceamount": 40,
"frequencyType": null,
"name": "Bitewing X-rays (4 image)"
},
{
"frequency": 0,
"mceamount": 61,
"frequencyType": null,
"name": "Routine Cleanings"
},
{
"frequency": 0,
"mceamount": 29,
"frequencyType": null,
"name": "Routine Oral Exams"
}
],
"covers": "Covers 0%"
},
{
"dentalType": null,
"inNetworkPercent": 0,
"outOfNetworkPercent": 0,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
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"frequency": 0,
"mceamount": 80,
"frequencyType": null,
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},
{
"frequency": 0,
"mceamount": 82,
"frequencyType": null,
"name": "Fillings (2 surface amalgam)"
},
{
"frequency": 0,
"mceamount": 100,
"frequencyType": null,
"name": "Fillings (2 surface resin)"
},
{
"frequency": 0,
"mceamount": 77,
"frequencyType": null,
"name": "Panoramic X-Rays"
}
],
"covers": "Covers 0%"
},
{
"dentalType": null,
"inNetworkPercent": 0,
"outOfNetworkPercent": 0,
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"dentalPlanTypeIncentive": [],
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{
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{
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{
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{
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{
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"frequencyType": null,
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}
],
"covers": "Covers 0%"
}
],
"waived": [],
"waivedLabeled": false
},
"Platinum": {
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"marketingInEffect": "2020-10-01T00:00:00",
"outOfEffect": "2024-09-30T00:00:00",
"marketingOutOfEffect": "2024-09-30T00:00:00",
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"orthoEliminationPeriod": 0,
"examFrequency": 2,
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"annualPlanMax": 1500,
"outOfNetAnnualPlanMax": 1500,
"rewardsThreshold": 750,
"rewardsAnnualRollover": 250,
"ppobonus": 150,
"rewardsMaxRollover": 1000,
"waitingPeriod": null,
"notes": null,
"deductible": 50,
"familyDeductibleMax": 150,
"dentalRewards": true,
"planLevel": "Platinum",
"dentalNetworkDescription": "Non-PPO \/ Out-Of-Network Benefits",
"frequencyType": "Annual",
"carrier": {
"fullName": "Ameritas Life Insurance Corp",
"shortName": "Ameritas",
"logo": "\/img\/ameritas.png",
"creativeApproval": "2020-03-11T19:51:51.743",
"legalName": "Ameritas Life Insurance Corp (Ameritas Life)",
"website": "https:\/\/dentalnetwork.ameritas.com\/",
"phone": "1-877-983-3582",
"instructions": "Enter zip, select city & state, and Classic PPO network."
},
"dentalPlanCoverage": [
{
"rate": 58.71,
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},
{
"rate": 113.84,
"coverage": "Member +1"
},
{
"rate": 191.13,
"coverage": "Member +Family"
}
],
"dentalPlanType": [
{
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"inNetworkPercent": 1,
"outOfNetworkPercent": 1,
"deductibleWaived": true,
"dentalPlanTypeIncentive": [],
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{
"frequency": 1,
"mceamount": 0,
"frequencyType": "Plan Period",
"name": "Bitewing X-rays"
},
{
"frequency": 2,
"mceamount": 0,
"frequencyType": "Plan Period",
"name": "Routine Cleanings"
},
{
"frequency": 2,
"mceamount": 0,
"frequencyType": "Plan Period",
"name": "Routine Oral Exams"
}
]
},
{
"dentalType": null,
"inNetworkPercent": 0.8,
"outOfNetworkPercent": 0.8,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Denture Repair"
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{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Fillings"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Panoramic X-Rays"
}
]
},
{
"dentalType": null,
"inNetworkPercent": 0.5,
"outOfNetworkPercent": 0.5,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Crown Repair"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Crowns"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Dentures"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Endodontics (root canals)"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Extractions (simple and complex) "
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "General Anesthesia"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Implants"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Periodontics (gum disease)"
}
]
}
],
"inEffectDate": "2020-10-01",
"inEffectTimestamp": 1601510400,
"outOfEffectDate": "2024-09-30",
"outOfEffectTimestamp": 1727654400,
"marketingInEffectDate": "2020-10-01",
"marketingInEffectTimestamp": 1601510400,
"inEffectDateCalc": "2020-10-01",
"marketingOutOfEffectDate": "2024-09-30",
"marketingOutOfEffectTimestamp": 1727654400,
"planLevelText": "Most Comprehensive",
"frequencyText": "per year & per person",
"frequencyTextAlt": "per year\/person",
"planCoverage": [
{
"rate": 58.71,
"coverage": "Member"
},
{
"rate": 113.84,
"coverage": "Member +1"
},
{
"rate": 191.13,
"coverage": "Member +Family"
}
],
"planType": "dental",
"types": [
{
"dentalType": null,
"inNetworkPercent": 1,
"outOfNetworkPercent": 1,
"deductibleWaived": true,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"frequency": 1,
"mceamount": 0,
"frequencyType": "Plan Period",
"name": "Bitewing X-rays"
},
{
"frequency": 2,
"mceamount": 0,
"frequencyType": "Plan Period",
"name": "Routine Cleanings"
},
{
"frequency": 2,
"mceamount": 0,
"frequencyType": "Plan Period",
"name": "Routine Oral Exams"
}
],
"covers": "Covers 100%"
},
{
"dentalType": null,
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"outOfNetworkPercent": 0.8,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
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{
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"mceamount": 0,
"frequencyType": null,
"name": "Denture Repair"
},
{
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"mceamount": 0,
"frequencyType": null,
"name": "Fillings"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Panoramic X-Rays"
}
],
"covers": "Covers 80%"
},
{
"dentalType": null,
"inNetworkPercent": 0.5,
"outOfNetworkPercent": 0.5,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Crown Repair"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Crowns"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Dentures"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Endodontics (root canals)"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Extractions (simple and complex) "
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "General Anesthesia"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Implants"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Periodontics (gum disease)"
}
],
"covers": "Covers 50%"
}
],
"waived": [
1
],
"waivedLabeled": [
"Preventative"
]
}
},
"procedures": {
"X-Rays": {
"bitewing 4 image)": 1,
"panoramic)": 1,
"bitewing)": 1
},
"Routine Cleanings": {
"": 1
},
"Routine Oral Exams": {
"": 1
},
"Denture Repair": {
"maxillary)": 1,
"": 1
},
"Fillings": {
"2 surface amalgam)": 1,
"2 surface resin)": 1,
"": 1
},
"Crown": {
"full cast noble metal)": 1,
"all types)": 1
},
"Dentures": {
"maxillary)": 1,
"all types)": 1
},
"Extractions": {
"simple)": 1,
"simple and complex)": 1
},
"General Anesthesia": {
"": 1
},
"Implants": {
"": 1
},
"Root Canal": {
"premolar tooth)": 1,
"all types)": 1
},
"Crown Repair": {
"": 1
},
"Periodontics": {
"": 1
}
},
"coverage": {
"Member": {
"Gold": 45.85,
"Platinum": 58.71
},
"Member +Associate": [],
"Member +Spouse": [],
"Member +1": {
"Gold": 87.12,
"Platinum": 113.84
},
"Member +Family": {
"Gold": 137.86,
"Platinum": 191.13
},
"Member +Children": []
},
"annualPlanMax": {
"Gold": 1250,
"Platinum": 1500
},
"outOfNetAnnualPlanMax": {
"Gold": 1250,
"Platinum": 1500
},
"rewardsThreshold": {
"Gold": 500,
"Platinum": 750
},
"rewardsAnnualRollover": {
"Gold": 250,
"Platinum": 250
},
"rewardsMaxRollover": {
"Gold": 1000,
"Platinum": 1000
},
"type_1": {
"inNetworkPercent": {
"Gold": 0,
"Platinum": 1
},
"outOfNetworkPercent": {
"Gold": 0,
"Platinum": 1
},
"deductibleWaived": {
"Gold": false,
"Platinum": true
},
"services": {
"X-Rays": {
"Gold": 1,
"Platinum": 1
},
"Routine Cleanings": {
"Gold": 1,
"Platinum": 1
},
"Routine Oral Exams": {
"Gold": 1,
"Platinum": 1
}
}
},
"type_2": {
"inNetworkPercent": {
"Gold": 0,
"Platinum": 0.8
},
"outOfNetworkPercent": {
"Gold": 0,
"Platinum": 0.8
},
"deductibleWaived": {
"Gold": false,
"Platinum": false
},
"services": {
"Denture Repair": {
"Gold": 1,
"Platinum": 1
},
"Fillings": {
"Gold": 1,
"Platinum": 1
},
"X-Rays": {
"Gold": 1,
"Platinum": 1
}
}
},
"type_3": {
"inNetworkPercent": {
"Gold": 0,
"Platinum": 0.5
},
"outOfNetworkPercent": {
"Gold": 0,
"Platinum": 0.5
},
"deductibleWaived": {
"Gold": false,
"Platinum": false
},
"services": {
"Crown": {
"Gold": 1,
"Platinum": 1
},
"Dentures": {
"Gold": 1,
"Platinum": 1
},
"Extractions": {
"Gold": 1,
"Platinum": 1
},
"General Anesthesia": {
"Gold": 1,
"Platinum": 1
},
"Implants": {
"Gold": 1,
"Platinum": 1
},
"Root Canal": {
"Gold": 1,
"Platinum": 1
},
"Crown Repair": {
"Platinum": 1
},
"Periodontics": {
"Platinum": 1
}
}
}
};