Network of Providers
Duke has an expanded network of providers who have agreed to accept usual and customary (U&C) for covered services. Under the dental plans, participants are still able to visit any licensed dentist. You can find a network provider by calling Ameritas at 1-800-487-5553 or by visiting the Ameritas web site.
Duke employees can choose from three dental options that offer different levels of coverage and different ways of choosing a dentist. Duke's dental plans are available to retirees who have continued their dental insurance in retirement.
All three plans cover some or all of the cost of:
- preventive procedures such as exams and cleaning,
- basic services such as fillings, sealants, denture repair and removal of teeth, and
- major services such as crowns, dentures and root canals.
Fee schedules for all three plans are available on the Ameritas website.
Preferred Provider Option (PPO) Plan
The PPO plan includes a higher maximum annual benefit than Plan A and Plan B, lower negotiated procedure rates and your out of pocket costs are usually lower. However, participants in the PPO will need to select an in-network provider. If you select the PPO and use an out-of-network provider, the amount the plan pays will be based on discounted network charges and you will be responsible for any amount charged over that allowance. A list of network dentists is available at ameritas.com or by calling Ameritas at 1-800-755-8844.
Plan A and Plan B
If you enroll in Plan A, you can select any licensed dentist of your choice. You may also choose to use a network provider. Using a network provider will limit your out of pocket cost. Also, if you utilize a network provider, the deductible is waived for all covered procedures.
Plan B provides a very basic benefit and payments are based on a fixed schedule of fees. The schedule for Plan B is available on the Ameritas website at ameritas.com. You should review the fixed schedule before selecting this option.
How to Increase Your Annual Maximum Benefit
All three plans have an annual maximum benefit. If you reach this annual maximum benefit, Ameritas will not reimburse any additional services for the remainder of the calendar year. Dental plan members who have at least one covered dental claim filed in calendar year 2019, with less than $500 in claims payments, will have their annual maximum benefit increased by $250 in 2020. This accumulation can continue each year until the annual maximum has increased in the PPO plan from $1,250 to $2,250; on Plan A from $1,000 to $2,000; and on Plan B from $750 to $1,750.
If you and/or your dependent(s) are not currently enrolled for dental coverage through Duke and enroll for 2021, you and/or your dependent(s) will be considered a "late entrant." As a "late entrant" your benefits during 2021 will be limited to preventive services: two preventive routine care exams (not including X-rays), two prophylaxis (routine) cleanings, and for children under age 19, one fluoride application. No other dental or orthodontia procedures or services will be covered during the first 12 months, if a member is enrolled as a late entrant.
Periodontal procedures, including maintenance/ cleanings, would not be covered during this 12-month period.
Once you have been enrolled in a Duke dental plan for at least 12 months, the plan will also cover basic and major procedures such as fillings, extractions, crowns, root canals and periodontal treatment (including periodontal maintenance which applies towards cleaning frequency).
This 12-month waiting period does not apply:
- if you are switching from one Duke dental plan to another Duke plan,
- if you enroll an eligible dependent within 30 days of a qualifying event such as marriage or adoption, or
- if you add a child during an open enrollment period prior to his/her second birthday.