PPO Plan In-Network | Plan A | Plan B | |
---|---|---|---|
Annual maximum benefit for preventive, basic and major covered services | $2,000 per person | $1,250 per person | $1,000 per person |
Late Entrant Provision (see definition here) | Applies | Applies | Applies |
Preventive:All three plans cover: | |||
| No deductible Covered in full up to the MAC1. | No deductible Covered in full up to U&C2. | No deductible Pays a predetermined fixed amount3 based on procedure received. |
Basic:All three plans cover: | |||
| No deductible; Reimbursement at:
| After $100 lifetime deductible per person; Reimbursement at:
| After a combined basic and major annual deductible of $50 per person, the plan pays a predetermined fixed amount3 based on procedure received. |
Major:All three plans cover: | |||
| After a $50 calendar year deductible per person; Reimbursement at:
| After a $75 calendar year deductible per person; Reimbursement at:
| After a combined basic and major annual deductible of $50 per person, the plan pays a predetermined fixed amount3 based on procedure received. |
Orthodontia: | |||
All three plans cover orthodontia 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.