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. The Annual Maximum for the PPO plan is $1,500; on Plan A is $1,250; and, on Plan B is $1,000. If you reach the Annual Maximum benefit, Ameritas will not reimburse any additional services for the remainder of the calendar year. However, if you have Dental Rewards carryover, those accumulated dollars can go towards additional covered benefits. Dental plan members who have at least one covered procedure during the calendar year and have total paid claims under $500 in the calendar year will automatically carryover or “bank” $250 Dental Rewards dollars. If a member visits a participating network provider, an additional $100 PPO Bonus is added to the carryover benefit. A member can continue to increase the Dental Rewards carryover each year until the total accumulation reaches $1,000 in carryover benefit. This Dental Rewards carryover is in addition to the Annual Maximum. Any Dental Rewards dollars accumulated will automatically be used if the member has approved claims that go beyond their Annual Maximum benefit. Only these approved claims will be considered for benefit reimbursement through accumulated carryover dollars. Please note, a member must visit the dentist once each calendar year for a covered procedure in order to earn and maintain any Dental Rewards carryover.
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.