Coverage

Davidson College provides two different levels of coverage that employees can evaluate based on personal need.  Both offer excellent preventative care coverage and have different levels of coverage for other procedures. 

High Plan Coverage Summary

Service	Coverage Amounts
Type I Routine Exams (2 per benefit period) X-rays Cleaning Fluoride for Children (18 and under) Sealants (16 and under)	Paid at 100%
Type 2 Restorative Amalgams and Composites Endodontics Periodontics Denture Repair Extractions Anesthesia	Paid at 80%
Type 3 Inlays Onlays Crowns (1 in 5 years) Crown Repair Prosthodontics (1 in 5 years	Paid at 50%
Orthodontia (Child Only) Coinsurance Lifetime Maximum (per person) Waiting Period	50% $1,000 None
Deductible	$50/calendar year (waived for Type 1)  $150/Family
Maximum (per person) is $1,500 per calendar year

Low Plan Coverage Summary

Service	Coverage Amounts
Type I Routine Exams (2 per benefit period) X-rays Cleaning Flouride for Children (18 and under) Sealants (16 and under)	Paid at 100%
Type 2 Restorative Amalgams and Composites Denture Repair Simple Extractions	Paid at 80%
Type 3 None	None
Orthodontia	None
Deductible	$50/calendar year (waived for Type 1)   No Family Maximum
Maximum (per person) is $750 per calendar year

Important Information

• Both plans allow you to qualify to carry over a portion of your unused annual maximum to use toward future covered dental expenses, up to a set maximum.  Call Ameritas for process information.
• Pretreatment - No pre-authorization is required; however, they are recommended for any dental work that you consider expensive.  Your dentist may submit the information for a pretreatment estimate to Ameritas' customer relations department.  You will be informed of the exact amount your insurance will cover and the amount for which you will be responsible.  That way, there will not be any surprises!
• Dental Rewards - a program that “rewards” members who are taking good preventive health measures and not utilizing all of their dental maximum. 

Eligibility

• All regular full-time employees, effective the first of the month after 30 days of continuous service
• All regular part-time employees (budgeted for at least 1,000 hours/year), effective the first of the month after 60 days of continuous service

Cost

Coverage	High Plan	Low Plan
Employee Only	Monthly $27.72 Bi-weekly $12.79	Monthly $15.76 Bi-weekly $7.27
Employee + Spouse	Monthly $58.36 Bi-weekly $26.94	Monthly $35.20 Bi-weekly $16.25
Employee + Child(ren)	Monthly $65.80 Bi-weekly $30.37	Monthly $44.60 Bi-weekly $20.58
Family	Monthly $98.44 Bi-weekly $45.43	Monthly $66.04 Bi-weekly $30.48

Forms, Links and Vendor Information

Ameritas (Website)
Dental Plan Summary
Ameritas Dental Claim Form
Dental (Plan Description)
Dental Rewards Program Explanation

Plan Administrator

Davidson College

Member Services

Ameritas Customer Relations

800-487-5553 (8:00 am - 1:00 am Monday through Thursday; 8:00 am - 7:30 pm Friday)

Last Update 10/22/08