Grad Employee Dental Insurance
The Ameritas Fusion dental plan features:
100% coverage for preventative care, like exams and 4 cleanings/plan year
80% coverage for procedures like fillings
65% coverage for more involved procedures, like crowns
Orthodontic for adults and coverage for children to age 19
$2250 calendar year maximum--you can use $150 of this toward any remaining vision materials costs after EyeMed vision insurance is applied
Reimbursement for out-of-network benefits will be based on the 95th percentile of “reasonable and customary” charges (see description for details).
There's no deductible when you see an in-network dentist (a once per year deductible applies for out-of-network providers: $75 for individuals and an aggregate $225 for families.)
Please review the plan full description before utilizing the coverage.
Please note: starting 9/1/20, the benefits plan year is 9/1-8/31 meaning your dental plan year maximum renews each 9/1, as does any responsibility to pay a deductible.
Who can be covered?
Eligible graduate employees, their dependent spouses, same and opposite sex domestic partners, and children up to age 26. No other family members are eligible for coverage under the plan.
Finding a dentist
You can search for an in-network Ameritas dentist in any zip code. When prompted, our network is Classic PPO Plus. You can also call Customer Connections department at 800 - 487 - 5553.
You should always confirm that your dentist or facility is participating in our network at the time you make your appointment.
Dental Providers Outside the US
For dental or vision service needs outside the USA, call AXA Assistance USA, Inc. (AXA) at 866-662-2731 (toll free) or 312-935-3727 (collect call) for a referral. Providers referred by AXA are not members of the Ameritas and Ameritas Life Insurance Corp. of New York (Ameritas of New York) PPO Network. Referral to an AXA provider is not a guarantee of benefits, and all policy provisions and limitations would apply.
Note: These provider referral assistance services are independently offered and administered by AXA. Ameritas and Ameritas Life Insurance Corp. of New York and its affiliates and subsidiaries do not participate in the selection of these dental and vision service providers and do not oversee or monitor AXA's performance of these services. Additionally, Ameritas and Ameritas of New York do not warrant or guarantee or make any representation as to the quality of the services provided by AXA or by any dental or vision service provider referred by AXA.
Relevant Plan Documents
Click here for the Ameritas Claim Form and send claims to:
Group Claim Office
PO Box 82520
Lincoln, NE 68501
Click here for the Ameritas Coordination of Benefits Policy.
The dental plan is free for eligible individuals. Family plans are available with a premium contribution. The Trust Fund subsidizes the cost of the single+1 and family plan to ensure the employee premium is affordable.
single plan: FREE
single + 1 plan: (you + a spouse/partner or 1 child): $100/year
family plan: (you + multiple dependents): $100/year
Using Benefits Out-of-Network
While you maximize your benefits when seeing an Ameritas dentist, you can still choose to go out-of-network. Reimbursement for your out-of-network benefits are based on the 95th percentile of “reasonable and customary” charges (see description for details). To request out-of-network reimbursement, complete this claim form and attach your receipt from the dental office. Submit these items to Ameritas according to the instructions on the claim form.
Important to Note!
It's important to ask your dentist for a pre-treatment estimate prior to having procedures beyond basic cleanings. That way, you'll know in advance exactly what portion of the costs your benefits will cover and what you will be required to pay out of pocket.
Starting 9/1/20, the benefits plan year is 9/1-8/31 meaning your dental plan year maximum renews each 9/1, as does any responsibility to pay a deductible.
Some dentists are choosing to charge an extra fee for the cost of their Personal Protective Equipment (PPE) used during your visit. Most dental insurance is not covering PPE fees. The Trust Fund has created a limited, first-come-first-served reimbursement fund to address PPE fees charged to you and not covered by insurance.
What documentation is required?
PPE fees are usually coded as D1999 on your Estimate of Benefits (EOB) from Ameritas--the EOB is the preferred way to document this charge for purposes of reimbursement. Alternately, we can accept a bill or letter from your dentist. Either way, to be eligible for reimbursement, documentation must show your name (or the name of an eligible dependent on your plan), date of service, amount paid and designation as PPE not covered by insurance. Please redact all other personal information on your documentation. Log in to your dashboard at hwtrust.geouaw.org to submit your documentation.
This reimbursement is completely separate from the wellness reimbursement. Due to the limited pool of funds for this benefit, reimbursement is not guaranteed and is subject to final approval by the Trust Fund Board of Trustees.
Using the Fusion Vision Benefit
Your Ameritas dental plan allows you to use up to $150 of your $2250 plan year maximum to reimburse any out-of-pocket vision materials costs not already covered by your EyeMed vision plan.
You can submit a claim, including a copy of your receipt, for reimbursement up to your vision plan benefit. Claims should be
submitted within 90 days. Click here for the claim form.
Quick video on how to claim the $150 Ameritas vision reimbursement here!
Please see answers to common questions about completing the online vision reimbursement form below: