- 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, and more
- High annual maximum
that can increase after one year
Member
$27.64/month
$53.92/month
Member +1
$55.28/month
$107.85/month
Member +Family
$82.89/month
$137.57/month
Deductible
$50.00
per year/person
(waived for Preventative services)
$75.00 per year/person
In Network
$1,000.00 per year/person
$1,500.00 per year/person
Out of Network
$1,000.00 per year/person
$1,500.00 per year/person
Annual Benefit Threshold
$0.00
$500.00
Annual Maximum Benefit
$1,000.00
$1,500.00
Dental Rewards Carry Over
$0.00
$250.00
Year 2 Maximum Benefit
$1,000.00
$1,750.00
Total Maximum Benefit
$1,000.00
$2,500.00
Preventative
Routine Cleanings
M.C.E. $39
Covers 100%
Routine Oral Exams
M.C.E. $16
Covers 100%
Basic
X-Rays
M.C.E. $17 (bitewing 4 image)
M.C.E. $47 (panoramic)
Covers 80% (all types)
Fillings
M.C.E. $53 (2 surface amalgam)
M.C.E. $53 (2 surface composite anterior)
Covers 80%
Crown Repair
M.C.E. $59
Covers 80%
Denture Repair
Not Covered
Covers 80%
Major
Crown
M.C.E. $218 (full cast noble metal)
Covers 50% (all types)
Crown Repair
M.C.E. $59
Covers 80%
Dentures
M.C.E. $293 (maxillary)
Covers 50% (all types)
General Anesthesia
M.C.E. $55
Covers 50%
Root Canal
M.C.E. $176 (premolar tooth)
Covers 50% (all types)
Extractions (simple and complex)
Not Covered
Covers 50%
Oral Surgery
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 January, 2019 to 31 December, 2024.
{
"services": {
"Routine Cleanings": {
"Gold": "M.C.E. $39",
"Platinum": "Covers 100%"
},
"Routine Oral Exams": {
"Gold": "M.C.E. $16",
"Platinum": "Covers 100%"
},
"X-Rays": {
"Gold": "M.C.E. $17 (bitewing 4 image)<\/span>
M.C.E. $47 (panoramic)<\/span>",
"Platinum": "Covers 80% (all types)<\/span>"
},
"Fillings": {
"Gold": "M.C.E. $53 (2 surface amalgam)<\/span>
M.C.E. $53 (2 surface composite anterior)<\/span>",
"Platinum": "Covers 80%"
},
"Crown Repair": {
"Platinum": "Covers 80%",
"Gold": "M.C.E. $59"
},
"Denture Repair": {
"Platinum": "Covers 80%"
},
"Crown": {
"Gold": "M.C.E. $218 (full cast noble metal)<\/span>",
"Platinum": "Covers 50% (all types)<\/span>"
},
"Dentures": {
"Gold": "M.C.E. $293 (maxillary)<\/span>",
"Platinum": "Covers 50% (all types)<\/span>"
},
"General Anesthesia": {
"Gold": "M.C.E. $55",
"Platinum": "Covers 50%"
},
"Root Canal": {
"Gold": "M.C.E. $176 (premolar tooth)<\/span>",
"Platinum": "Covers 50% (all types)<\/span>"
},
"Extractions (simple and complex)": {
"Platinum": "Covers 50%"
},
"Oral Surgery": {
"Platinum": "Covers 50%"
},
"Periodontics": {
"Platinum": "Covers 50%"
}
},
"plans": {
"Gold": {
"inEffect": "2023-01-01T00:00:00",
"marketingInEffect": "2022-11-15T00:00:00",
"outOfEffect": "2024-12-31T00:00:00",
"marketingOutOfEffect": "2024-11-14T00:00:00",
"policyNumber": null,
"cleaningsPerPeriod": 2,
"cleaningPeriod": "Benefit Period",
"orthoEliminationPeriod": 0,
"examFrequency": 2,
"examPeriod": "Benefit Period",
"orthoCoverageDescription": "None",
"orthoLifetimeMax": 0,
"orthoCoInsurance": 0,
"annualPlanMax": 1000,
"outOfNetAnnualPlanMax": 1000,
"rewardsThreshold": 0,
"rewardsAnnualRollover": 0,
"ppobonus": 0,
"rewardsMaxRollover": 0,
"waitingPeriod": null,
"notes": null,
"deductible": 50,
"familyDeductibleMax": 0,
"dentalRewards": false,
"planLevel": "Gold",
"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": 27.64,
"coverage": "Member",
"areaName": null
},
{
"rate": 55.28,
"coverage": "Member +1",
"areaName": null
},
{
"rate": 82.89,
"coverage": "Member +Family",
"areaName": null
}
],
"dentalPlanRateBandState": [],
"dentalPlanType": [
{
"dentalType": null,
"inNetworkPercent": 0,
"outOfNetworkPercent": 0,
"deductibleWaived": true,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"frequency": 2,
"mceamount": 39,
"frequencyType": null,
"name": "Routine Cleanings"
},
{
"frequency": 2,
"mceamount": 16,
"frequencyType": null,
"name": "Routine Oral Exams"
}
]
},
{
"dentalType": null,
"inNetworkPercent": 0,
"outOfNetworkPercent": 0,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"frequency": 0,
"mceamount": 17,
"frequencyType": null,
"name": "Bitewing X-rays (4 image)"
},
{
"frequency": 0,
"mceamount": 53,
"frequencyType": null,
"name": "Fillings (2 surface amalgam)"
},
{
"frequency": 0,
"mceamount": 53,
"frequencyType": null,
"name": "Fillings (2 surface composite anterior)"
},
{
"frequency": 0,
"mceamount": 47,
"frequencyType": null,
"name": "Panoramic X-Rays"
}
]
},
{
"dentalType": null,
"inNetworkPercent": 0,
"outOfNetworkPercent": 0,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"frequency": 0,
"mceamount": 218,
"frequencyType": null,
"name": "Crown (full cast noble metal)"
},
{
"frequency": 0,
"mceamount": 59,
"frequencyType": null,
"name": "Crown Repair"
},
{
"frequency": 0,
"mceamount": 293,
"frequencyType": null,
"name": "Denture (maxillary)"
},
{
"frequency": 0,
"mceamount": 55,
"frequencyType": null,
"name": "General Anesthesia"
},
{
"frequency": 0,
"mceamount": 176,
"frequencyType": null,
"name": "Root Canal (premolar tooth)"
}
]
}
],
"inEffectDate": "2023-01-01",
"inEffectTimestamp": 1672552800,
"outOfEffectDate": "2024-12-31",
"outOfEffectTimestamp": 1735624800,
"marketingInEffectDate": "2022-11-15",
"marketingInEffectTimestamp": 1668492000,
"inEffectDateCalc": "2022-11-15",
"marketingOutOfEffectDate": "2024-11-14",
"marketingOutOfEffectTimestamp": 1731564000,
"startTimestamp": 1730437200,
"isInEffect": true,
"marketingIsInEffect": true,
"planLevelText": "Essential Coverage",
"frequencyText": "per year & per person",
"frequencyTextAlt": "per year\/person",
"planCoverage": [
{
"rate": 27.64,
"coverage": "Member",
"areaName": null
},
{
"rate": 55.28,
"coverage": "Member +1",
"areaName": null
},
{
"rate": 82.89,
"coverage": "Member +Family",
"areaName": null
}
],
"planType": "dental",
"types": [
{
"dentalType": null,
"inNetworkPercent": 0,
"outOfNetworkPercent": 0,
"deductibleWaived": true,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"frequency": 2,
"mceamount": 39,
"frequencyType": null,
"name": "Routine Cleanings"
},
{
"frequency": 2,
"mceamount": 16,
"frequencyType": null,
"name": "Routine Oral Exams"
}
],
"covers": "Covers 0%"
},
{
"dentalType": null,
"inNetworkPercent": 0,
"outOfNetworkPercent": 0,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"frequency": 0,
"mceamount": 17,
"frequencyType": null,
"name": "Bitewing X-rays (4 image)"
},
{
"frequency": 0,
"mceamount": 53,
"frequencyType": null,
"name": "Fillings (2 surface amalgam)"
},
{
"frequency": 0,
"mceamount": 53,
"frequencyType": null,
"name": "Fillings (2 surface composite anterior)"
},
{
"frequency": 0,
"mceamount": 47,
"frequencyType": null,
"name": "Panoramic X-Rays"
}
],
"covers": "Covers 0%"
},
{
"dentalType": null,
"inNetworkPercent": 0,
"outOfNetworkPercent": 0,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"frequency": 0,
"mceamount": 218,
"frequencyType": null,
"name": "Crown (full cast noble metal)"
},
{
"frequency": 0,
"mceamount": 59,
"frequencyType": null,
"name": "Crown Repair"
},
{
"frequency": 0,
"mceamount": 293,
"frequencyType": null,
"name": "Denture (maxillary)"
},
{
"frequency": 0,
"mceamount": 55,
"frequencyType": null,
"name": "General Anesthesia"
},
{
"frequency": 0,
"mceamount": 176,
"frequencyType": null,
"name": "Root Canal (premolar tooth)"
}
],
"covers": "Covers 0%"
}
],
"waived": [
1
],
"waivedLabeled": [
"Preventative"
]
},
"Platinum": {
"inEffect": "2019-01-01T00:00:00",
"marketingInEffect": "2019-01-01T00:00:00",
"outOfEffect": "2024-12-31T00:00:00",
"marketingOutOfEffect": "2024-11-14T00:00:00",
"policyNumber": "350794",
"cleaningsPerPeriod": 2,
"cleaningPeriod": "Benefit Period",
"orthoEliminationPeriod": 0,
"examFrequency": 2,
"examPeriod": "Benefit Period",
"orthoCoverageDescription": "None",
"orthoLifetimeMax": 0,
"orthoCoInsurance": 0,
"annualPlanMax": 1500,
"outOfNetAnnualPlanMax": 1500,
"rewardsThreshold": 500,
"rewardsAnnualRollover": 250,
"ppobonus": 100,
"rewardsMaxRollover": 1000,
"waitingPeriod": null,
"notes": "OON to MAC on Type 2 & 3 on Platinum plan",
"deductible": 75,
"familyDeductibleMax": 0,
"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": 53.92,
"coverage": "Member",
"areaName": null
},
{
"rate": 107.85,
"coverage": "Member +1",
"areaName": null
},
{
"rate": 137.57,
"coverage": "Member +Family",
"areaName": null
}
],
"dentalPlanRateBandState": [],
"dentalPlanType": [
{
"dentalType": null,
"inNetworkPercent": 1,
"outOfNetworkPercent": 1,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"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": "Crown Repair"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Denture Repair"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Fillings"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "X-rays"
}
]
},
{
"dentalType": null,
"inNetworkPercent": 0.5,
"outOfNetworkPercent": 0.5,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"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": "Oral Surgery"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Periodontics (gum disease)"
}
]
}
],
"inEffectDate": "2019-01-01",
"inEffectTimestamp": 1546322400,
"outOfEffectDate": "2024-12-31",
"outOfEffectTimestamp": 1735624800,
"marketingInEffectDate": "2019-01-01",
"marketingInEffectTimestamp": 1546322400,
"inEffectDateCalc": "2019-01-01",
"marketingOutOfEffectDate": "2024-11-14",
"marketingOutOfEffectTimestamp": 1731564000,
"startTimestamp": 1730437200,
"isInEffect": true,
"marketingIsInEffect": true,
"planLevelText": "Most Comprehensive",
"frequencyText": "per year & per person",
"frequencyTextAlt": "per year\/person",
"planCoverage": [
{
"rate": 53.92,
"coverage": "Member",
"areaName": null
},
{
"rate": 107.85,
"coverage": "Member +1",
"areaName": null
},
{
"rate": 137.57,
"coverage": "Member +Family",
"areaName": null
}
],
"planType": "dental",
"types": [
{
"dentalType": null,
"inNetworkPercent": 1,
"outOfNetworkPercent": 1,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"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,
"inNetworkPercent": 0.8,
"outOfNetworkPercent": 0.8,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Crown Repair"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Denture Repair"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Fillings"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "X-rays"
}
],
"covers": "Covers 80%"
},
{
"dentalType": null,
"inNetworkPercent": 0.5,
"outOfNetworkPercent": 0.5,
"deductibleWaived": false,
"dentalPlanTypeIncentive": [],
"dentalPlanTypeProcedure": [
{
"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": "Oral Surgery"
},
{
"frequency": 0,
"mceamount": 0,
"frequencyType": null,
"name": "Periodontics (gum disease)"
}
],
"covers": "Covers 50%"
}
],
"waived": [],
"waivedLabeled": false
}
},
"procedures": {
"Routine Cleanings": {
"": 1
},
"Routine Oral Exams": {
"": 1
},
"X-Rays": {
"bitewing 4 image)": 1,
"panoramic)": 1,
"all types)": 1
},
"Fillings": {
"2 surface amalgam)": 1,
"2 surface composite anterior)": 1,
"": 1
},
"Crown": {
"full cast noble metal)": 1,
"all types)": 1
},
"Crown Repair": {
"": 1
},
"Dentures": {
"maxillary)": 1,
"all types)": 1
},
"General Anesthesia": {
"": 1
},
"Root Canal": {
"premolar tooth)": 1,
"all types)": 1
},
"Denture Repair": {
"": 1
},
"Extractions": {
"simple and complex)": 1
},
"Oral Surgery": {
"": 1
},
"Periodontics": {
"": 1
}
},
"coverage": {
"Member": {
"Gold": 27.64,
"Platinum": 53.92
},
"Member +Associate": [],
"Member +Spouse": [],
"Member +1": {
"Gold": 55.28,
"Platinum": 107.85
},
"Member +Family": {
"Gold": 82.89,
"Platinum": 137.57
},
"Member +Children": []
},
"annualPlanMax": {
"Gold": 1000,
"Platinum": 1500
},
"outOfNetAnnualPlanMax": {
"Gold": 1000,
"Platinum": 1500
},
"rewardsThreshold": {
"Gold": 0,
"Platinum": 500
},
"rewardsAnnualRollover": {
"Gold": 0,
"Platinum": 250
},
"rewardsMaxRollover": {
"Gold": 0,
"Platinum": 1000
},
"type_1": {
"inNetworkPercent": {
"Gold": 0,
"Platinum": 1
},
"outOfNetworkPercent": {
"Gold": 0,
"Platinum": 1
},
"deductibleWaived": {
"Gold": true,
"Platinum": false
},
"services": {
"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": {
"X-Rays": {
"Gold": 1,
"Platinum": 1
},
"Fillings": {
"Gold": 1,
"Platinum": 1
},
"Crown Repair": {
"Platinum": 1
},
"Denture Repair": {
"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
},
"Crown Repair": {
"Gold": 1
},
"Dentures": {
"Gold": 1,
"Platinum": 1
},
"General Anesthesia": {
"Gold": 1,
"Platinum": 1
},
"Root Canal": {
"Gold": 1,
"Platinum": 1
},
"Extractions (simple and complex)": {
"Platinum": 1
},
"Oral Surgery": {
"Platinum": 1
},
"Periodontics": {
"Platinum": 1
}
}
}
};