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 no deductibles, a higher maximum annual benefit than Plan A and Plan B, and lower negotiated procedure rates. These provisions can lower participants' out-of-pocket expenses when using in-network dentists.
However, participants in the PPO plan must use an in-network provider. Prior to signing up for the PPO plan, you should review the network to make sure you are comfortable with the number of providers in your area. If you do not plan to use an in-network provider, do not sign up for the PPO plan.
A list of in-network dentists is available here.
Plan A and Plan B
With Plan A and Plan B, you may visit any licensed dentist. Both plans include deductibles that must be met before coverage begins for non-preventive procedures.
Plan A and Plan B reimburse participants based on the usual and customary (U&C) allowable charge for each covered service. Plan A has higher monthly premiums than Plan B, but reimburses participants more of the cost of the service. If a dentist charges more than the U&C charge, the participant is responsible for the excess charge.
How to Increase Your Annual Maximum Benefit
Dental plan members having had at least one covered dental service in the prior calendar year and having less than $500 in claims payments will have their annual maximum benefit increased by $250 in the following year.
The Benefit Threshold is $500. Dental benefits received for the year cannot exceed this threshold amount. The Annual Carryover Amount is $250 plus an additional $100 if the member visits a network provider. The maximum possible accumulation for Dental Rewards is $1000. This Dental Rewards benefit is in addition to the Annual Maximum of the members chosen plan.
Late Entrant Restrictions
If you do not enroll within 30 days after your date of hire or eligibility, and enroll instead during the open enrollment period in the fall, you will be considered a "late entrant". As a "late entrant," your benefits during the first twelve months of coverage 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 procedure 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 insurance plan for at least 12 months, the insurance will also cover basic and major procedures such as fillings, extractions, crowns, root canals, and periodontal treatment (including periodontal maintenance which apply toward 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 add a child during an open enrollment period prior to his/her second birthday, or
- if you enroll an eligible dependent within 30 days of a qualifying event such as marriage or adoption.