First Ameritas Group - frequently asked questions

How do I obtain a copy of my dental benefits?
Most plans will send you a certificate booklet outlining your dental benefits once you have been enrolled under the group. However, if you have not received a certificate booklet you can contact Customer Relations.

What is my ID number?
Your ID number in most instances is usually your social security number. However, some plans use a policy number/division number/certificate number for the ID number.

Do I need an ID card?
You do not need an ID card. ID cards are offered by some plans as a convenient way to present your insurance information to the dentist. Some plans do not issue cards. In place of an ID card you may give your dental office your group number, which includes the policy number/division number/certificate number. For your group number please contact Customer Relations.

How do I obtain a corrected ID card if there's an error on it?
Contact Customer Relations in order to have your name or ID number corrected. Some Benefit Administrators send us your member information electronically; therefore, we may have to refer you back to your Benefit Administrator, as they will have to update the information.

Can I upgrade my plan or add more coverage?
Most plans have one set of benefits available. Normally, if there is a choice among plan options or upgrades your Benefit Administrator would share this information with you during your enrollment period. To obtain an answer to this question, please contact your Benefit Administrator.

What is the Late Entrant limitation?
If you enroll into the group dental plan later than 31 days after becoming eligible, you are considered a late entrant. There may be benefit limitations set by Benefit Administrators and insurance carriers regarding late entrants. Please refer to your certificate booklet for more details.

Why aren't all the procedures covered right away – why is there an Elimination Period?
Some plans utilize an elimination period, which is a time period defined within the structure of your group dental plan and beginning immediately on your effective date, that must be satisfied before benefits on certain procedures become available. Because Elimination Periods are sometimes called Waiting Periods, care should be taken not to confuse the two terms.

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Determining Benefits

How do I obtain my benefit information?
Your benefit information is located in your certificate booklet or on this web site under Dental Benefit Summary. This will include the general benefits and procedure frequencies of your plan. You can also ask your dentist or specialist to submit a pretreatment estimate for specific procedures that you consider to be expensive. You can also contact Customer Relations for more detailed benefit information.

Who is authorized to obtain benefit information and claim status on my dental policy?
The Health Insurance Portability and Accountability Act (HIPAA) took effect on April 14, 2003. In accordance with HIPAA, we are required by law to maintain the privacy of our insured members' and their dependents' protected health information. The privacy law allows the member to obtain benefit information and claim status on all individuals insured under his/her dental policy. If the spouse is on the policy, he/she is allowed information on dependents under the age of 18 also. The member may complete the Privacy Form and return it to our company to authorize others to access the information.

Do I need to have a pretreatment estimate?
No, you don't need to have a pretreatment estimate. However, we recommend that a pretreatment estimate be submitted for all anticipated work that you consider to be expensive. Pretreatment estimates are the best way for you to determine your anticipated out-of-pocket expense. For more information on submitting a pretreatment estimate visit How to Submit a Claim or Pretreatment Estimate. Pretreatment estimates, sometimes called predeterminations and prestatements, are offered as a service to you and your dentist or specialist but are not a requirement.

How many exams, cleanings, and x-rays are covered?
The frequencies are predetermined by your policy. For your policy frequencies see your certificate booklet or the Dental Benefit Summary service on this web site. You can also contact Customer Relations.

My periodontal specialist told me I should have three or four cleanings a year, but my plan only covers two…why is this?
The number of covered cleanings for each benefit period is established by the benefits and limitations/exclusions of your group dental plan. We are obligated to apply the plan provisions consistently for all members regardless of individual circumstances. Our denial of your additional cleanings does not suggest that the services should not be performed. We do not intervene in treatment decisions between a dentist or specialist and patient nor do we determine dental necessity.

What is covered of wisdom-teeth removal (oral surgery)?
Depending upon your plan's benefits, Oral surgery can fall under the Preventive, Basic, or Major category. Please refer to your certificate booklet. A pre-operative x-ray film is required in order to review a surgical extraction because benefits are subject to our consultant's review. Obtaining a pretreatment estimate is recommended for all dental work that you consider to be expensive. The estimate helps to eliminate misunderstandings by letting you know beforehand how much the plan can cover. We do suggest submitting your oral surgery claim to your medical plan first as some medical plans have benefits for surgical extractions as well as general anesthesia or IV sedation.

How are orthodontic benefits paid?
Under most plans, benefits are released in a maximum of 8 quarterly payments with the first payment being released three (3) months after the banding date. Quarterly payments will be released automatically thereafter. Records are paid out separately. Benefits released for the records will reduce your remaining orthodontic maximum. For specifics on your plan's orthodontic benefits, please check your certificate booklet or Dental Benefit Summary section of this web site.

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Choosing a Dentist

Can I see any dentist or specialist or must I choose one from your list?
Our insured members always have a choice in selecting their own dentist or specialist. However, many of our plans have PPO benefits, which give you access to our nationwide network of participating dentists and specialists, often resulting in lower out-of-pocket expenses. Some PPO plans also offer higher benefit percentages, increased maximums, and/or reduced deductibles when treatment is performed by a participating dentist or specialist. For a description of your plan or to find out if you have PPO access, choose Dental Benefit Summary on this web site. If you have PPO benefits this will be clearly outlined on this web site or in your certificate booklet. If you have any additional questions about your choice of dentist or specialist and how it may impact benefits, please contact Customer Relations.

What if I have a complaint about my dentist or specialist?
If you are dissatisfied with the quality of care received from a dentist or specialist, you can contact Customer Relations for assistance. However, an insurance company is not able to intervene in these disputes and has no authority to do so. When the claim has already been received and processed, our contractual obligations have been met. These disputes should be resolved between the insured and the dentist or specialist.

Peer Review is an organization that can act as a mediator between insurance consultants and a dentist or specialist, investigate complaints, and recommend a course of action. Please contact Customer Service for peer review information for your state. If the dispute involves a PPO dentist, please contact Customer Relations.

How do I know if my dentist or specialist is part of the PPO network?
The Find a Provider search on this web site includes the name, location, hours, and languages spoken for each participating dentist or specialist in the Ameritas PPO network. If you have additional questions about your dentist's or specialist's status in the Ameritas PPO network, please contact Provider Relations.

Do I need a referral to see another dentist or specialist?
No, members are welcome to seek treatment from any dentist of their choice. If you have PPO coverage, we suggest utilizing an Ameritas participating dentist and participating specialist to help maximize your benefits and lower your out-of-pocket expenses. Some PPO plans also offer higher benefit percentages, increased maximums, and/or reduced deductibles when treatment is performed by a participating dentist.

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The Appointment

What do I bring to my appointment?
If you have an ID card, please take this with you. However, some groups do not offer ID cards so you can either give the dental office your ID number or group number. If you do not know your group number you can contact Customer Relations. You might also consider taking your certificate booklet with you, or a print out from Dental Benefit Summary on this web site.

How much will I have to pay at the time of my appointment?
You may be responsible for your deductible and co-insurance. However, some dental offices will not collect the deductible or co-insurance until after the claim has been processed by insurance. Please contact your dental office to see how they do their billing.

Do I need to bring a claim form?
In most instances you do not need to bring a claim form with you. If the dental office submits insurance claims for you they already have claim forms. However, if the dental office requires that you file your own claim(s) with insurance please ensure that the dentist or specialist gives you a statement. Please complete only the top portion (Part 1) of a claim form with the patient and member information and attach a copy of the statement to the claim form to submit to us.

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Claims Submission

Who submits the claim or Pretreatment Estimate?
If your plan has the PPO option and you go to a participating dentist or specialist they will submit claims and Pretreatment Estimates for you. However, if you see a non-participating dentist or specialist you will need to contact your dental office to see if they will submit the claims or Pretreatment Estimates for you.

How much time do I have to submit the claim?
We recommend that claims be submitted as soon as possible as dental plans have a timely filing clause. Unless otherwise noted in your certificate booklet, active insured members must submit claims to us within 15 months of the date of service. However, if you are no longer an active insured member with us you have 90 days from your termination date to submit all claims to us. Claims submitted after these time frames will be denied due to timely filing requirements.

Will you send benefit payments to me or to the dentist/specialist?
We will assign benefits according to how it is authorized on the claim form, if services are performed in the United States. If services are performed outside of the United States, benefits will automatically be assigned to the insured. If you visit a PPO dentist or specialist, based on their contractual agreement, benefit payments are automatically issued directly to the dentist or specialist. For non-participating dentists and specialists, benefits can be assigned to the insured or to the dentist or specialist. If you would like the benefits assigned to you, please leave the authorization line blank.

What is your fax number for claims submission?
Claims not requiring x-ray films may be faxed to 402-467-7336.

What is your mailing address for claims submission?
Group Claims
P.O. Box 82595
Lincoln, NE 68501-2595

Do I have to use a certain claim form?
No, you can use any standard dental claim form as we do not require our own original claim form to be used. But, if you would like one, you may download and print a claim form here.

What information do you need for my student-dependent?
Please contact Customer Relations for the most current information.

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Understanding Payment and our Benefit Statements (Claim Explanations)

How do I check claim information?
To access claim information online, use the Dental Member Account (once logged in, click Member Information) or One-patient Dental Access (once logged in, click Patient Information) services on this site. If you have additional questions about claim information, please contact Customer Relations.

How do I get a copy of a Benefit Statement?
Please contact Customer Relations for a copy of a Benefit Statement.

Why did you take the deductible again on my claim? I already paid it to the dental office.
Most likely, the deductible is not being taken twice (once by us and once by the dental office). If the dentist collected the deductible from you we note the deductible for our records, and this is reflected on your Benefit Statement. If you feel an error has been made on your Benefit Statement please contact Customer Relations.

Why are you paying the dental office? I already paid them.
We pay according to how benefits are authorized on the claim form. If the authorization field is signed by you, which releases benefit payment to the dental office, benefits will be paid to your dental office. If your plan has the PPO option and you visit a participating dentist or specialist, benefits will be assigned to them per their contractual agreement. If you are being charged upfront for the full amount of your services by a participating dentist or specialist, please contact Customer Relations.

Why did you pay me? Payment was supposed to go to the dental office.
We pay according to how benefits are authorized on the claim form. If the authorization field is signed by you, which releases benefit payment to the dental office, benefits will be paid to your dental office.