Name: Hollywood Smile Premier 1500
Brand: Ameritas

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person 90001 | Applicant,35 edit

$31.21 /mo.

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Hollywood Smile Premier 1500

Plan Type PPO

Dentist Search

$31.21 /mo.

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Plan Highlights

As long as you meet the plan's general eligibility requirements and pay the applicable premium, your acceptance is automatic
You can also include all eligible children under your guardianship
The Hollywood Smile Premier 1500 Plan is a PPO plan
The Hollywood Smile Premier 1500 Plan helps pay the cost of most dental care services, including exams, cleanings, fillings, extractions, crowns, bridges and dentures
Money-saving Preventive Plus benefit offered with this plan - Type 1 Preventive procedures are not deducted from the plan's annual maximum benefit. This saves all of the annual benefit to help pay for more expensive Type 2 (Basic) and 3 (Major) procedures.
Hearing benefit available with this plan (Not available in MA, NH, and NM)
Apply online for your convenience and have the cost of insurance automatically deducted from your checking or savings account. That way you will have no extra checks to write and no new due dates to remember

Common Procedures

Details

Fee Schedule: N/A | Dentist Search

Exams: Routine periodic examinations twice in a benefit year
In-Network:
1st year – 80% after deductible
2nd year – 90% after deductible
3rd year and after – 100% after deductible
Out-of-Network:
1st year – 50% after deductible
2nd year – 60% after deductible
3rd year and after – 70% after deductible
Preventive – No waiting period

Cleanings: Teeth Cleanings – three in a benefit year
In-Network:
1st year – 80% after deductible
2nd year – 90% after deductible
3rd year and after – 100% after deductible
Out-of-Network:
1st year – 50% after deductible
2nd year – 60% after deductible
3rd year and after – 70% after deductible
Preventive – No waiting period

X-Rays: Radiography: Bitewing and full-mouth x–rays
In-Network:
1st year – 50% after deductible
2nd year – 60% after deductible
3rd year and after – 80% after deductible
Out-of-Network:
1st year – 30% after deductible
2nd year – 40% after deductible
3rd year and after – 50% after deductible
Basic – No waiting period

Fillings: Restorative Amalgam Fillings. Resin–based composite (white fillings) anterior only
In-Network:
1st year – 50% after deductible
2nd year – 60% after deductible
3rd year and after – 80% after deductible
Out-of-Network:
1st year – 30% after deductible
2nd year – 40% after deductible
3rd year and after – 50% after deductible
Basic – No waiting period

Extractions: Extractions and other oral surgery, including pre– and post–operative care
In-Network:
1st year – 20% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Out-of-Network:
1st year – 10% after deductible
2nd year – 20% after deductible
3rd year and after – 30% after deductible
Major – No waiting period

Crowns: In-Network:
1st year – 20% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Out-of-Network:
1st year – 10% after deductible
2nd year – 20% after deductible
3rd year and after – 30% after deductible
Major – No waiting period

Root Canals: Endodontics: Pulpal therapy and root canals
In-Network:
1st year – 20% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Out-of-Network:
1st year – 10% after deductible
2nd year – 20% after deductible
3rd year and after – 30% after deductible
Major – No waiting period

Dentures: In-Network:
1st year – 20% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Out-of-Network:
1st year – 10% after deductible
2nd year – 20% after deductible
3rd year and after – 30% after deductible
Major – No waiting period

Deep Cleanings: Treatment of diseases of the gums
In-Network:
1st year – 20% after deductible
2nd year – 30% after deductible
3rd year and after – 50% after deductible
Out-of-Network:
1st year – 10% after deductible
2nd year – 20% after deductible
3rd year and after – 30% after deductible
Major – No waiting period

Implants: Not Covered Service

Braces / Orthodontia: Not Covered Service

Teeth Whitening: Not Covered Service

Additional Network Information:

The Ameritas Dental Network is one of the nation’s largest. Network providers have agreed to charge 25-50% less than their regular rates which can lower your out-of-pocket costs.

The Maximum Allowable Charge (MAC) claim allowance is the maximum amount a network provider may charge. If you select a network provider, you may have lower out-of-pocket costs. If you visit an out-of-network dentist, the claim allowance is considered at the Maximum Allowable Benefit (MAB), which is equal to the lowest contracted fee in your ZIP Code. Any difference between the plan allowance and the dentist’s charge will be an out-of-pocket expense for you.

You can visit any dentist, in- or out-of-network. And family members do not need to visit the same provider.

Find a dental provider near you.
WV Only: West Virginia Network Access Plan

PPO Plans not available in all states.

Exclusions and Limitations
Plan Brochure: N/A
Summary of Dental Benefits and Coverage Disclosure Matrix

Notes:

Hearing Benefit Included: $75 Exam + Materials Benefit Maximum: $200 year 1, $300 year 2, $400 year 3
Benefits are available for hearing exams and hearing aids. Each benefit period you receive up to $75 for eligible hearing exams. The plan pays 50% of the hearing aid cost up to the maximum benefit. The maximum benefit is $200 day 1, $300 after year 1, and $400 after year 2.
Five years after using your hearing aid coverage, you are re-eligible for the benefit at the top level. A reduced benefit is available after three years if your current hearing aids can no longer correct your hearing. All benefits assume no break in coverage.
Hearing Benefit - not available in states of MA, NH, and NM

FAQ

Can I change my dentist once I am in the plan?

Yes, you may change your dentist at any time.

What is a pre-existing condition versus work-in-progress? Is it covered?

What provider options do I have?

When can I start using my Plan?

When will I receive my new member kit and what will it include?

Who can enroll in this plan?

Ameritas Life Insurance Corp.
5900 O Street Lincoln
Lincoln, NE 68510

Disclaimers & Disclosures

Ameritas Life Insurance Corp.:

Underwritten by Ameritas Life Insurance Corp. | 5900 O Street Lincoln, NE 68510

This is not a certificate of insurance or guarantee of coverage. Plan designs may not be available in all areas and are subject to individual state regulations. This piece is not for use in New Mexico. This information is provided by Ameritas Life Insurance Corp. (Ameritas Life). Dental, vision and hearing care products (9000 Rev. 03-16 for Group and 9000 Rev. 10-22 for Individual, dates may vary by state) are issued by Ameritas Life. The Dental and Vision Networks are not available in RI. In Texas, our dental network and plans are referred to as the Ameritas Dental Network. Ameritas, the bison design and “fulfilling life” are service marks or registered service marks of Ameritas Life, affiliate Ameritas Holding Company or Ameritas Mutual Holding Company. © 2024 Ameritas Mutual Holding Company.

Hearing is not available in the states of NH, NM and MA.

New Mexico:

Underwritten by Ameritas Life Insurance Corp. | 5900 O Street Lincoln, NE 68510

This is not a certificate of insurance or guarantee of coverage. Plan designs may not be available in all areas and are subject to individual state regulations. This information is provided by Ameritas Life Insurance Corp. (Ameritas Life). Dental and vision products (9000 NM Rev. 09-21 for Group and Indiv. 9000 NM Rev. 09-21 for Individual) are issued by Ameritas Life. Ameritas, the bison design and “fulfilling life” are service marks or registered service marks of Ameritas Life, affiliate Ameritas Holding Company or Ameritas Mutual Holding Company. © 2024 Ameritas Mutual Holding Company.

This website provides a very brief description of some of the important features of this plan. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exclusions and limitations is contained in the Schedule of Benefits and your policy.

Rates shown are based upon the information you provided, and are subject to change based on the dental and/or vision plan's underwriting practices and your selection of available optional benefits, if any. Final rates and effective dates are subject to underwriting and are always determined by the dental insurance and/or vision insurance company. To be considered for reimbursement, expenses must qualify as covered expenses.

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