Dental Plan Coverage

Your Employee Self Service

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The Dental Plan coverage has two categories of services. Type I & II services include preventive and basic care, and Type III services include major dental care. Whether or not you elect medical coverage, you can choose dental coverage for yourself and your eligible dependents who include your legally married spouse and/or your dependent children up to age 19, or up to age 24 if a full-time college student. For a complete list of covered Type I & II and Type III dental procedures visit www.ameritasgroup.com, call Ameritas at 800-487-5553, or view the plan description on Your Employee Self Service (YESS).

Ameritas issues cards to new enrollees only. If you had prior dental coverage with Ameritas you may continue to use the same card. If you need to order a new card, call Ameritas at 800.487.5553. Group # G-010-301008.

The level of coverage varies from 70% to 100% for Type I & II services and is determined by the number of years you are a member. You must have one covered service per benefit year in order to move up to the next percentage of coverage. If you fail to have a covered service in a given year, you will start over at the 70% coinsurance level.

Type I & II Services Type III Services
Covered Services Include Cleanings, fillings, denture repair, root canals, periodontics Crowns, inlays, bridges
Annual Deductible None $50 per participant
Lifetime Deductible $50 per participant None
Benefit Percentage: Preventive & Basic Care
(Max. $1,250)
70%-Year 1,
80%-Year 2,
90%-Year 3,
100%-Year 4+
Crowns, inlays, bridges
Benefit Percentage: Major & Restorative Care $1,250 per year per covered member, maximum Dental Reward accumulation of an additional $1000

50%
(Max $1,250)


Child Orthodontia Benefit: The child orthodontia benefit is available only to children who are banded prior to their 17th birthday (very important, must be prior to their 17th birthday) and had coverage at the time the orthodontia program began. The maximum lifetime benefit for child orthodontia is $1,250 per child. If both parents are eligible for dental coverage as NHRMC employees, the child is only eligible for one lifetime child orthodontia benefit. Orthodontia benefits are pro-rated and paid out by quarter over the estimated length of your child’s orthodontia program, but for no more than eight quarters (two years).

Late Entrant: If you do not enroll in the dental plan when you are first hired and elect to enroll during open enrollment, or if you discontinue dental coverage and re-enroll during open enrollment or a qualifying event, you will be considered a late entrant. Late entrants are not eligible for services other than cleanings for the first year. Covered expenses are limited to the lesser of the actual charge of the physician or dentist or the usual, customary and reasonable expense as determined by Ameritas. Information regarding your eligibility and remaining yearly allowance can be found at www.ameritasgroup.com.