Dental Plan Info

Dental Plans PRIMESTAR® Value PRIMESTAR® Access PRIMESTAR® Total
Cost
$23.12/month
$41.44
$51.95
Deductible(per benefit year)
$50
$50
$50
Maximum Benefit (per benefit year)
$750
Up to $2000
Up to $2,500
Preventive(Type 1) Coverage
90% → 100%
80% - 100%
100%
Type 1 Benefits

Exams (2 per year)
Cleanings (2 per year)

Exams (2 per year)
Cleanings (2 per year)
Fluoride (under age 16)
Sealants (under age 16)
Bitewing X-rays

Exams (2 per year)
Cleanings (2 per year)
Bitewing X-rays

Basic(Type 2) Coverage
50% → 80%
45% → 80%
80% → 90%
Type 2 Benefits

Fillings
Fluoride (under age 16)
Sealants (under age 16)
Bitewing X-rays

Fillings
Simple Extractions

Fillings
Simple Extractions

Major(Type 3) Coverage
0% → 15%
15% → 50%
20% → 50%
Type 3 Benefits

Crowns
Root Canals
Oral Surgery
Dentures
Bridges
Panoramic X-rays
Periodontics

Crowns
Root Canals
Teeth Whitening
Oral Surgery
Dentures
Bridges
Panoramic X-rays
Implants
Periodontics

Crowns
Root Canals
Oral Surgery
Dentures
Bridges
Panoramic X-rays
Implants
Periodontics

Other Benefits

N/A

Increasing Maximum:

$1,000 → $2,000 After 1 Year

LASIK Benefit:

$125 → $250/eye After 2 Years

Must be 18 or older

Increasing Maximum:

$2,000 → $2,500 After 1 Year

Hearing Benefit:

Receive $75 for eligible hearing exams

Pays 50% of hearing aid up to maximum benefit

Max Benefit: $200 - $300 - $400/day After Year 2

Preventive Plus

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 and 3 procedures.
*$50 deductible per person for Basic and Major services combined, with a maximum of three
deductibles per family.
**$750 maximum benefit per person for Basic and Major services combined.
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.

Ameritas

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. Find a Classic (PPO) network provider near you.

You can visit any dentist, in- or out-of-network. And family members do not need to visit the same provider. Use our dental cost estimator to find average procedure charges in your area. The estimates do not include network discounts or plan benefits.

 

Sign Up for savings!
By signing up using your information, you are agreeing to receive communications from ePro Associates. For more details, see our Privacy Policy