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Dental Care Plans Comparison Chart (2022)

Questions to Ask: Making Your Dental Plan Decisions

	PPO Plan In-Network	Plan A	Plan B
Annual maximum benefit for preventive, basic and major covered services	$1,500 per person	$1,250 per person	$1,000 per person
Late Entrant Provision (see definition here)	Applies	Applies	Applies
Coverage for Preventive Services:
2 routine exams per year 2 routine prophylaxis (cleanings) per year Space maintainers X-rays Fluoride treatments for children under age 19	No deductible Covered in full up to the MAC¹.	No deductible Covered in full up to U&C².	No deductible Members will pay the balance due after the plan reimburses based on the published fee schedule.
Coverage for Basic Services:
Fillings Sealants Full or partial denture repair Anesthesia for oral surgery Removal of teeth	No deductible; Reimbursement at: 80% of MAC¹ during first year of coverage 90% of MAC¹ during second year of coverage if a covered procedure is received during the first year 100% of MAC¹ thereafter if a covered procedure is received in the second and following years	After $100 lifetime deductible per person; Reimbursement at: 80% of U&C² during first year of coverage 90% of U&C² during second year of coverage if a covered procedure is received during the first year 100% of U&C² thereafter if a covered procedure is received in the second and following years	After a combined basic and major annual deductible of $50 per person, the plan pays a predetermined fixed amount³ based on procedure received.
Coverage for Major Services:
Crowns Bridgework Partial or full dentures Dentures, prosthodontics, and inlays Periodontal maintenace (periodontal cleaning) and gum treatment Endodontic procedures (root canals, etc.)	After a $50 calendar year deductible per person; Reimbusement at: 50% of MAC¹ 65% of MAC¹ for periodontic or gum treatment 65% of MAC¹ for endodontic procedures	After a $75 calendar year deductible per person; Reimbursement at: 50% of U&C² 65% of U&C² for periodontic or gum treatment 65% of U&C² for endodontic procedures	After a combined basic and major annual deductible of $50 per person, the plan pays a predetermined fixed amount³ based on procedure received.
Coverage for Orthodontia:
All three plans cover orthodontia (as described in the chart) only if treatment begins after the participant becomes covered by a Duke Dental Plan.	No deductible. 50% of U&C² $1,000 lifetime orthodontia maximum benefit per person (adults and children)	No deductible. 50% of U&C² $1,000 lifetime orthodontia maximum benefit per person (adults and children)	No deductible. 50% of U&C² $750 lifetime orthodontia maximum benefit per person (adults and children)

All payments are based on the Maximum Allowable Charges (MAC). PPO dentists have agreed to accept the contracted fee (MAC) as the maximum charge.
All payments are based on the usual and customary (U&C) allowable charge. You are responsible for charges over U&C.
The fee schedule, or reimbursement for each type of dental procedure, is available on the Ameritas website at ameritas.com.

Questions to Ask: Making Your Dental Plan Decisions

When comparing Duke's dental plans, it is important to compare out-of-pocket expenses as well as premiums. Here are some questions to ask yourself when choosing a dental plan that matches the needs of you and your family.

	PPO Plans	Plan A	Plan B
Can I visit any dentist?	No, you must use a network dentist	Yes, you may choose any licensed dentist or use a network dentist	Yes, you may choose any licensed dentist or use a network dentist
If I don't enroll within 30 days after my date of hire or eligibility and enroll in the future, will I be a "late entrant"?	Yes, please see below for more details	Yes, please see below for more details	Yes, please see below for more details
Will my dependent children who live in a different location be covered?	Yes, they may choose a dentist within a nationwide network	Yes	Yes
Is there a dental deductible before the insurance will pay for covered services?	Yes, an annual $50 deductible for "major" services	Yes, a $100 lifetime deductible for "basic" services and an annual $75 deductible for "major" services; the deductibles are waived if you use a network provider	Yes, a combined annual $50 deductible for "basic" and "major" services; the deductibles are waived if you use a network provider
Will I have out-of-pocket costs for preventive services?	No	Yes, cost sharing may be required if you visit a non- network dentist that charges above U&C	Yes
I need an existing filling replaced. Will it be covered if I enroll in a Duke dental plan?	Yes, if the filling is at least 6 months old	Yes, if the filling is at least 6 months old	Yes, if the filling is at least 6 months old
Are teeth whitening services covered under dental coverage?	No	No	No
Is a Pre-Treatment required?	We strongly suggest you ask your provider to submit a pre-treatment prior to expensive procedures such as crowns, bridges, root canals, etc.	We strongly suggest you ask your provider to submit a pre-treatment prior to expensive procedures such as crowns, bridges, root canals, etc.	We strongly suggest you ask your provider to submit a pre-treatment prior to expensive procedures such as crowns, bridges, root canals, etc.