Friday, June 23, 2017
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DENTAL BENEFITS

Culpeper County employees have the option of two dental plans through Ameritas.  Ameritas Dental pays benefits based upon the type of services received. 

 

To find a participating provider, visit http://www.ameritasgroup.com and select FIND A PROVIDER, then DENTAL.  Enter your criteria to search by location or for a specific dentist or practice.

 

If you have any additional questions about the plan, please call:  Ameritas Group Claims Department at 800.487.5553 or visit the Ameritas Website at http://www.ameritasgroup.com

 

 

DENTAL LOW PLAN OPTION

 

 

Monthly Rates
Employee Only $14.65
Employee + Spouse $27.85
Employee + Child(ren) $30.78
Employee + Family $46.90

 

Type 1 - Preventative and Diagnostic

 

Type 1 benefits are payable at 100% U&C*.  No Deductible applies.  

  • Routine Exam (2 per benefit period)
  • Bitewings x-rays (1 per benefit period)
  • Full Mouth/Panoramic X-rays ( 1 in 3 years)
  • Periapical X-rays
  • Cleaning (2 per benefit period
  • Fluoride for Children 18 and under (1 per benefit period)
  • Bitewings x-rays
  • Sealants (age 15 and under)
  • Space Maintainers

 Annual Maximum Benefit

Type 1 Procedures - $1,000 per calendar year per person.

  

Eligible Employees

You are eligible for insurance if you are a full-time employee.

 

Eligible Dependents 

Provides Coverage On:

Your Spouse

Children up to age of 26 regardless of student status

 

 

  DENTAL HIGH PLAN OPTION

 

 

Monthly Rates
Employee Only $31.06
Employee and Spouse $59.03
Employee and Child (ren) $65.24
Employee and Family $99.41

 

COMBINED CALENDAR YEAR DEDUCTIBLE

 

$50.00 per individual for Type 2 (Basic) and Type 3 (Major) Procedures (3 times family limit).

After the date that 3 covered family members have each satisfied their individual deductible, the entire deductible or any remaining portion of the deductible for any family member will be waived for the rest of that calendar year.

 

TYPE 1 - PREVENTATIVE AND DIAGNOSTIC

 

Type 1 benefits are payable at 100% (U&C*) No deductible applies.

  • Routine Exam (2 per benefit period)
  • Bitewings x-rays (1 per benefit period)
  • Full Mouth/Panoramic x-rays (1 in 3 years)
  • Sealants (age 15 and under)
  • Fluoride for Children 18 and under (1 per benefit period)

TYPE 2 - BASIC PROCEDURES

 

Type 2 benefits are payable at 80% (U&C*).  $50.00 deductible applies.

  • Restorative Amalgam
  • Anesthesia
  • Restorative Composites (anterior and posterior teeth)
  • Endodontic (surgical and nonsurgical)
  • Periodontics (surgical and nonsurgical)

TYPE 3 - MAJOR PROCEDURES

 

Type 3 benefits are payable at 50% (U&C*).  $50.00 deductible applies.

  • Onlays
  • Crowns ( 1 in 5 years per tooth)
  • Prosthodontics (fixed bridge; removable complete/partial dentures; 1 in 5 years)

ANNUAL MAXIMUM BENEFIT

 

Type 1,2, and 3 Procedures - $1,000 per calendar year per person.

 

ELIGIBLE EMPLOYEES

 

You are eligible for insurance if you are a full-time active employee.

 

ELIGIBLE DEPENDENTS

 

Provides Coverage on:

  • Your Spouse
  • Children up to the age of 26 regardless of student status

 

*Percentage Paid based on Usual and Customary Charges.

DENTAL PPO PLAN OPTION

With this option you must see an in-network provider.

Monthly Rates
Employee Only $27.37
Employee and Spouse $52.01
Employee and Child (ren) $57.48
Employee and Family $87.59

COMBINED CALENDAR YEAR DEDUCTIBLE

$50.00 per individual for Type 2 (Basic) and Type 3 (Major) Procedures (3 times family limit).

After the date that 3 covered family members have each satisfied their individual deductible, the entire deductible or any remaining portion of the deductible for any family member will be waived for the rest of that calendar year.

TYPE 1 - PREVENTATIVE AND DIAGNOSTIC

Type 1 benefits are payable at 100% (U&C*) No deductible applies.

  • Routine Exam (2 per benefit period)
  • Bitewings x-rays (1 per benefit period)
  • Full Mouth/Panoramic x-rays (1 in 3 years)
  • Sealants (age 15 and under)
  • Fluoride for Children 18 and under (1 per benefit period)

TYPE 2 - BASIC PROCEDURES

Type 2 benefits are payable at 80% (U&C*).  $50.00 deductible applies.

  • Restorative Amalgam
  • Anesthesia
  • Restorative Composites (anterior and posterior teeth)
  • Endodontic (surgical and nonsurgical)
  • Periodontics (surgical and nonsurgical)

TYPE 3 - MAJOR PROCEDURES

Type 3 benefits are payable at 50% (U&C*).  $50.00 deductible applies.

  • Onlays
  • Crowns ( 1 in 5 years per tooth)
  • Prosthodontics (fixed bridge; removable complete/partial dentures; 1 in 5 years)

ANNUAL MAXIMUM BENEFIT

Type 1,2, and 3 Procedures - $1,000 per calendar year per person.

ELIGIBLE EMPLOYEES

You are eligible for insurance if you are a full-time active employee.

ELIGIBLE DEPENDENTS

Provides Coverage on:

  • Your Spouse
  • Children up to the age of 26 regardless of student status

*Percentage Paid based on Usual and Customary Charges.