You’ll need the following information to complete the application process:

• Your personal information, including your Social Security Number
• Your banking information, including your account number, routing number and bank address (only applicable if you’d like payments electronically withdrawn from your account)
• Your dependent’s personal information, including Social Security Number(s)and date(s) of birth (only applicable if you’re including coverage for dependents

The security of your information is of the utmost importance to us. Our website is SSL Secure (Secure Sockets Layer), which means all data transmitted is an encrypted link between the web server and the browser. This link ensures all data passed between the web server and browser remains private. SSL is an industry standard for web security and is used by millions of websites in the protection of online transactions.

You use your Application User ID and password to sign in and view your application information or check the status of your submitted application. You may exit the application process at any time and any information you entered will be saved. To come back later and finish your application, you’ll just need to sign in with your Application User ID and password. The Application User ID and password is only valid for 60 days.

Your Application User ID and password is valid for 60 days.

Use your Application User ID and password during the application process to view your application or check on the status of your application. Once you’re approved for coverage, you can create a secure member account. This is where you’ll access benefit and claims information.

If you were previously covered under a dental plan, you may be eligible for takeover benefits, which means waiting periods are waived. During the application process you will be asked to complete and submit a replacement form and provide information about your prior plan, including the date of termination. You may be required to provide an evidence of coverage letter from your prior carrier. The letter must include a termination date of the prior plan that is no more than 30 days prior to the date we receive your application for coverage. Takeover benefits apply only to MyDental Plans 1, 2 and 3.

Once you submit a completed application for individual coverage, we begin processing your application. Once your application is approved, you’ll receive a notification e-mail. At that time, we’ll mail you your policy and ID cards. Carefully review your policy and ID cards. Your policy will include your effective date (the date when coverage begins).

The Replacement Notice notifies you of items to consider before replacing an existing dental plan with this dental plan. You will receive a copy of the replacement notice during the application process. Read it carefully and print a copy to save for your records.

The Outline of Coverage is a brief description of the plan design. You will receive a copy of the Outline of Coverage when you apply for insurance – review it completely before submitting your application. For future reference, keep a copy of the Outline of Coverage for the plan that you have selected.

When applying for coverage you can choose to make your premium payments monthly, quarterly, semi-annually or annually.

You can make premium payments by credit card, EFT (electronic funds transfer) or check. There is an $8 administrative fee applied each time you pay your premium by check.

We accept Visa, MasterCard, American Express and Discover.

You’ll see the first billing for your premium when your application is approved. After that, the premium amount will be billed on the first business day of the month for each month of coverage. If you select quarterly, semi-annual or annual premium payments, the premium will be billed on the first business day of the selected period.

EFT is a payment method where premium payments are automatically drafted from your checking or savings account on a regular basis. Monthly EFT payments are typically drafted on the first business day of the month.

You’ll see the first draft for your premium come out when your application is approved. After that, the premium amount will be drafted on the first business day of the month for each month of coverage. If you select quarterly, semi-annual or annual premium payments, the draft for the whole premium will come out on the first business day of the selected period.

Yes, you’ll receive a billing statement. Send your premium payment prior to the due date to ensure there is no lapse in your coverage.

There is an $8 administrative fee applied each time you pay your premium by check.

If you forget to make your premium payment and it’s less than 31 days past the due date, contact us at 800-237-1276 or [email protected]. If it’s more than 31 days from the date the premium is due, your coverage has lapsed and will be terminated.

You will be eligible to reinstate 12 months from the date you last had coverage from us. You will need to reapply for coverage at that time.

You will be covered by your policy on your chosen effective date, provided your application has been approved and we’ve received your first premium payment. You can choose an effective date during the application process. The effective date must be the first date of one of the three months following the date your application is received by us. All effective dates are on the first day of the month.

Your dependents are eligible for coverage either the day you become effective or within 31 days of becoming an eligible dependent. If applying for dependent coverage more than 31 days after your effective date, your dependent will be treated as a late entrant.

Child eligibility depends upon age and student status at the time of services. Refer to your Policy for details.

If you enroll dependents more than 31 days after they became eligible, they will be considered late entrants. There are benefit limitations regarding late entrants. Refer to your Policy for more details.

Once you’ve applied and been approved for coverage you will receive a Policy outlining your benefits. If you’ve already applied and been approved and you have not received a Policy, contact us at 800-487-5553 or [email protected].

An elimination period or waiting period is a time period defined within the structure of some dental plans that begins on the effective date. The elimination period must be satisfied before benefits on certain procedures become available.

Yes, if you are traveling or have a covered dependent living in a different state, you will still have coverage.

Your ID number is the policy/division/certificate number located on your ID card. You may also use your Social Security Number.

No, you don’t need an ID card. ID cards are provided with some plans as a convenient way to present your insurance information to the dental provider. If you don’t have an ID card you can give your dental office your ID number or Social Security Number. If you don’t know your ID number, contact us at 800-487-5553 or [email protected].

Contact us at 800-487-5553 or [email protected] to receive an updated ID card.

You can only change plans at renewal. Contact us at 800-487-5553 or [email protected] to discuss changing your plan.

All cancellations must be submitted to HealthPlan Services by calling 800-237-1276 or writing PO Box 30102, Tampa, FL 33630-3264. Once the request is received, the policy will be canceled either the first day of the following month or the requested cancellation date (must be the first of a month).

In accordance with the Health Insurance Portability and Accountability Act (HIPAA) we are required by law to maintain the privacy of our insured members’ and their dependents’ protected health information. If you are an insured member, the privacy law allows you to obtain benefit information and claim status on all individuals insured under your policy. If your spouse is on the policy, he or she is allowed to obtain information on dependents under the age of 18. If you’d like to authorize others to access benefit information, complete our Privacy Form and submit it to us at:

Privacy Office
PO Box 81889
Lincoln, NE 68510
Fax: 402-309-2580

No, you don’t need to have a pretreatment estimate. However, we recommend that a pretreatment estimate be submitted for all anticipated work that you consider expensive. Pretreatment estimates are the best way for you to determine your anticipated out-of-pocket expense. For more information, visit How to Submit a Claim or Pretreatment Estimate.

The frequencies of covered procedures are predetermined by your policy. To check your frequencies, sign into your secure member account at ameritasgroup.com/member or check your certificate. You can also contact us at 800-487-5553 or [email protected].

The number of covered cleanings for each benefit period is established by the benefits and limitations/exclusions of your dental plan. We are obligated to apply the plan provisions consistently for all plan members regardless of individual circumstances. Our denial of your additional cleanings doesn’t suggest that the services shouldn’t be performed. We do not intervene in treatment decisions between a dental provider and patient nor do we determine dental necessity.

Depending upon your plan’s benefits, oral surgery can fall under the Basic or Major category. Refer to your certificate for your plan benefit details. A pre-operative x-ray film is required in order to review a surgical extraction because benefits are subject to our consultant’s review. We recommend obtaining a pretreatment estimate for all dental work you consider to be expensive. This estimate helps to eliminate misunderstandings by letting you know beforehand how much the plan can cover. We also suggest submitting your oral surgery claim to your medical plan first, as some medical plans have benefits for surgical extractions and general anesthesia or IV sedation.

A missing tooth clause explains any coverage limitations related to teeth missing or extracted prior to your effective date of coverage. The missing tooth clause can vary depending upon your plan, so be sure to check your certificate of coverage for details.

By submitting at least one dental claim each year and keeping your total benefits received for the year at or below the specified Threshold Amount, you can earn an Annual Reward that you carry over to increase your annual maximum benefit available the next year. You can accumulate rewards up to the specified Maximum Reward amount. If no dental claims are submitted during a year, no rewards are earned and any accumulated rewards are lost; the rewards balance reverts to $0. But you can begin building rewards again the very next year. Dental Rewards® is available only on MyDental Plans 1, 2 and 3.

No, our individual plans don’t include benefits for orthodontia. However, in some states we offer discounts on non-covered procedures. Check with your provider for details.

Plan 3 includes a $100 vision benefit you may use for exams, frames, lenses or contact lenses from the vision provider of your choice. You’ll also receive a vision ID card that explains how to access discounts on eye exams and products. You are free to visit any vision provider you choose. However, if you visit an EyeMed provider you may benefit from additional savings on eye wear and services. If you choose to use your vision benefit, it’s deducted from the total annual maximum allowed for dental benefits. If you use your plan’s entire annual maximum benefit for dental care, no vision benefit will be available that year.

You may benefit from greater out-of-pocket savings when you visit a dental provider on the Ameritas dental PPO network.

You are always free to visit any dental provider you choose. However, you may benefit from greater out-of-pocket savings when you visit a dental provider on our PPO network. For a description of your plan or to find out if you have PPO access, sign into your secure member account at ameritasgroup.com/member and review your Dental Benefit Summary or certificate. If you have any questions about your choice of dental provider and how it may impact benefits, contact us at 800-487-5553 or [email protected].

Search for your dental provider in the Find a Provider directory on this website. If you have additional questions about your dental provider’s status on the Ameritas PPO network, contact us at 800-487-5553 or [email protected].

You can nominate your provider to become part of our network by completing the provider nomination form. Please understand that nominating a provider doesn’t guarantee they will become an active participant in the Ameritas PPO network.

No. You are welcome to seek treatment from any dental provider. If you have PPO coverage, we suggest using an Ameritas PPO dental provider to help maximize your benefits and lower your out-of-pocket expenses.

If you have concerns about the experience you have had with a participating provider, contact us at 800-487-5553 or [email protected].

Yes, however we only honor assignment of benefits to providers in the United States. Since services provided outside the United States must be reimbursed directly to the member, foreign-based providers typically require payment in full before services are completed. We do not have a PPO network outside the United States.

You will be responsible for your deductible and coinsurance. However, some dental offices will not collect the deductible or coinsurance until after the claim has been processed by insurance. Contact your dental office to ask how they do their billing.

In most instances you do not need to bring a claim form with you. If the provider office submits insurance claims for you, they already have claim forms. However, if the office requires that you file your own claim(s) with insurance, please make sure the provider or specialist gives you a statement. Complete only the top portion (Part 1) of a Dental Claim Form or Vision Claim Form with the patient and member information, attach a copy of the provider’s statement and submit to us at:

Ameritas Claims Department
PO Box 82520
Lincoln, NE 68501-2520
Fax: 402-467-7336

No. You are not required to use our claim form. You may use any standard dental or vision claim form.

• Dental Claim Form
• Vision Claim Form

We recommend that claims be submitted as soon as possible, as dental plans have a timely filing clause. Unless otherwise noted in your certificate, active insured members must submit claims to us within 90 days of the date of service. Claims submitted after 90 days will be denied due to failure to meet the timely filing requirements.

Claims that don’t require x-ray films may be faxed to 402-467-7336.

Ameritas Claims Department
PO Box 82520
Lincoln, NE 68501-2520

If services are performed in the United States, we’ll assign benefits according to how they are authorized on the claim form. If services are performed outside the United States, benefits will automatically be assigned to the insured member. If you visit a PPO dental provider, benefit payments are automatically issued directly to the provider based on their contractual agreement. For nonparticipating providers, benefits can be assigned to the insured member or to the provider. If you’d like the benefits assigned to you, please leave the authorization line blank on the claim form.

Please contact us at 800-487-5553 or [email protected] for the most current information.

An EOB is a statement that summarizes the processing of a claim. The statement includes date of service, services performed, provider identification, a summary of charges and explanations of payment or denial. It is also called a Benefit Statement or Claim Explanation.

Sign into your secure member account at ameritasgroup.com/member and choose Claim Information. You may also contact us at 800-487-5553 or [email protected] for a copy of your EOB.

In most cases we are not collecting the deductible/copayment twice (once by us and once by the dental office). If the dental provider collected the deductible/copayment from you, we note the deductible/copayment for our records and this is reflected on your EOB. If you feel an error has been made on your EOB, contact us at 800-487-5553 or [email protected].

We pay according to how benefits are authorized on the claim form. If you sign the authorization field on the claim form, benefit payment is released to the dental office and we will pay benefits to your dental office. If your plan has the PPO option and you visit a participating dental provider, benefits will be assigned to them per their contractual agreement. If you are being charged up front for the full amount of your services by a participating dental provider, contact us at 800-487-5553 or [email protected].

Ameritas pays according to how benefits are authorized on the claim form. If you sign the authorization field on the claim form, benefit payment is released to the dental office and we will pay benefits to your dental office.

An annual maximum is the maximum dollar amount a dental plan will pay toward the cost of dental care incurred by an individual or family in a calendar year.

A waiting period is a period of time a person must be enrolled in a plan before qualifying for benefits.

Coinsurance is an arrangement that assigns expenses between you and the insurer. You share in the cost of covered services on a percentage basis.