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100

What are the differences between Type 1, Type 2, and Type 3 dental services?

  • Type 1: Preventive (cleanings, exams)
  • Type 2: Basic (fillings, extractions)
  • Type 3: Major (crowns, dentures)
100

How do incentive and reverse incentive co-insurance models work?

  • Incentive: Coverage improves with continued enrollment and preventive care.
  • Reverse Incentive: Starts high and decreases if preventive care is not maintained.
100

What deductible types are available, and how do family maximums apply?

  • Deductibles apply per person, often waived for preventive care.
  • Family maximum caps total deductible for all covered members.
100

What are maximum rewards and prevention plus enhancements?

  • Maximum Rewards: Allows unused benefits to roll over.
  • Prevention Plus: Excludes preventive care from annual maximums.
100

How do annual maximums and lifetime maximums differ for dental coverage?

  • Annual applies to most dental services per year.
  • Lifetime applies to orthodontia or specific services.
100

What does the 90th UNC allowance mean for out-of-network coverage?

Out-of-network reimbursement based on 90th percentile of usual charges in the area.

100

How do ADA codes and procedure listings affect plan design?

Codes define covered procedures; limitations apply by age, frequency, and placement.

100

What network(s) does Ameritas Dental use?

Ameritas PPO network nationwide; passive PPO allows same benefits in/out of network.

100

How do Ameritas PPO and passive PPO networks differ?

PPO offers better pricing in-network; passive PPO pays same coinsurance regardless of network.

100

What does “In Network” & “Out of Network” mean for dental coverage?

  • In-network = negotiated rates, lower out-of-pocket.
  • Out-of-network = higher costs, based on UNC allowance.
100

Is Ameritas dental insurance portable when an employee leaves the company?

Group dental is not portable; COBRA may apply. Individual plans are separate.

100

What are the rules around waiting periods and late entrant penalties?

  • Standard waiting periods for major services; waived for takeover groups.
  • Late entrants may face penalties or limited coverage.
100

How are takeover provisions handled for dental plans?

Ameritas honors prior coverage to waive waiting periods for new groups.

100

How is orthodontia treated differently in Ameritas dental plans?

Separate lifetime maximum; coinsurance applies; age limits often under 19.

100

What are the typical age limits and lifetime maximums for orthodontia?

Typically under age 19; lifetime max varies by plan (e.g., $1,000–$2,000).

100

What documentation is required for accurate quoting?

Census, current plan summary, prior rates, claims experience for accurate quote.

100

How do group characteristics affect underwriting and rates?

Size, location, industry, participation, employer contribution affect rates.

100

What is the role of SIC codes in risk assessment?

Used to assess industry risk and set competitive pricing.

100

What is the difference between a Geo Access Report and a Disruption Report, and how would you request them to respond to an RFP?

  • Geo Access: Provider proximity analysis.
  • Disruption: Compares current provider usage to new network.
  • Request via Ameritas BD or underwriting team for RFP responses.
100

What is the structure of the Ameritas–Reliance Matrix partnership?

Ameritas handles dental/vision; Reliance Matrix manages life/disability. Shared BD support.

100

How can reps negotiate rates or interact with Ameritas underwriting?

Work through Ameritas BD and underwriting; provide competitive justification.

100

What plan design options are available (e.g., PPO, dual/triple options)?

PPO, passive PPO, dual/triple options for flexibility.

100

Who is your Ameritas Business Development Rep?

Name your assigned Ameritas BD contact for your region.

100

Who is your main Ameritas Underwriter?

Ameritas underwriting team handles case pricing and exceptions.

100

What billing options are available for dental, and is billing consolidated with life and disability?

Electronic and paper billing available; can consolidate with life/disability for ease.