Dental

 
Launch a full view of the presentation describing your dental and vision benefit options. More detailed information is available below and in the plan overview brochure.

Regular employees who work at least 20 hours per week, or 50% FTE, and who are included in payroll/benefit classifications designated by Cornell are eligible to apply for coverage under the Group Dental Insurance Plan. Your spouse (or domestic partner) and children are eligible. Children may be covered through December 31 of the year in which their 26th birthday occurs.

After you select your plan, there are several types of coverage in which you may enroll:

  • Employee Only Coverage (Individual)
  • Employee and Spouse/Domestic Partner
  • Employee and Child(ren)
  • Family

Please Note: New employees have 60 days from the date of hire to enroll. If you experience a qualified event (i.e. marriage), you must enroll within 60 days. Once you enroll, unless you experience a change in family status, you cannot stop or change your election until the next annual open enrollment period. Changes in family status include but are not limited to, birth, marriage, divorce, termination, dependent death.

A calendar year, January 1 through December 31, is the basis for your deductibles, maximums and coinsurance levels. During the first year you are insured, your calendar year is from your effective date through December 31 of that year.

Effective Date of Coverage: Changes made during Open Enrollment will be effective January 1. Outside of Open Enrollment, your benefits will become effective on the first day of the pay period after your date of hire or qualified event (i.e. marriage, divorce). If your date of hire or qualified event is the first day of the pay period, your effective date is the date of your hire/qualified event

1. Upon enrollment, you will receive ID cards with instructions to view your Certificate of Insurance and to obtain claim form. Additional claim forms can be obtained from your Benefits/ Human Resources office, Ameritas Life of New York, or through your secure member account (NY).


2. Dentists in the Ameritas Dental Network will file a claim for you. If you are visiting a provider outside the network, take the claim form with you to the dentist performing your service.


3. You complete Parts 1 and 3 of the claim form (NY). Part 1 is information about you and your employer. Part 3 allows you to have benefits paid directly to your dentist.


4. Your dentist completes Parts 2 and 4. Part 2 identifies the services that were performed. Part 4 certifies that the dentist performed the services.


5. Deadline to file a claim, also referred to as Proof of Loss. Written proof of loss must be given to us within 120 days after the incurred date of the services provided for which benefits are payable. If it is impossible to give written proof within the 120 day period, we will not reduce or deny a claim for this reason if the proof is filed as soon as is reasonably possible.


6. You or your dentist can send the claim form to: 
Ameritas Life Insurance Corp.of New York 
Group Dental Claims

P.O. Box 82595 
Lincoln, NE 68501

FAX: 402.467.7336

Email: group@ameritas.com

Unencrypted e-mail is susceptible to viewing by unauthorized parties. To ensure your confidentiality, it is important that you do not provide any information you consider confidential and/or personal in nature (i.e. Social Security Number, claim number, etc.)





Claim Procedure: Ameritas of New York provides each employee with instructions to view a Certificate of Insurance explaining the plan benefits and limitations in complete detail. For answers to your claims questions, call toll free, 1-800-659-5556. Dental claim forms are available in the quick links to the right.





Coordination of Benefits: If you or any of your dependents incur charges which are covered by any other group plan, the benefits of this plan will be coordinated with the benefits of the other plan so that the total benefits received are not greater than the charges incurred.





Estimate of Payment: If your dentist thinks charges for the proposed work will be $200 or more, you and your dentist can complete a claim form (NY) for pre-statement of benefits. Your dentist shows the work to be done and what the charges will be. The claim form (NY) is then sent to Ameritas of New York. Ameritas of New York will estimate your benefits and send a report to your dentist.

You have three dental plan options, Plan A+, Plan A and Plan B. Below is an overview of the three plans and links to view detailed plan comparisons.

Plan details

Plan overview brochure (with detailed plan comparison chart)
 Sample claim comparison

Coverage: Coverage and deductibles vary according to the plan you choose and the procedures you receive. An overview is available in the plan overview brochure listed above. Details are also listed on this site.

Covered Expenses: Expenses will be covered only for procedures performed by a dentist or dental hygienist. These expenses are subject to the “Dental Plan Limitations and Exclusions” listed in the brochure. If two or more procedures can be used as an appropriate treatment to correct a certain condition, the amount of the covered expense will be the charge for the least expensive procedure.

Expenses Incurred: An expense is incurred at the time the service is rendered or a supply is furnished; the impression is made for an appliance or change to an appliance; the tooth or teeth are prepared for a crown, bridge or gold restoration; or the pulp chamber is opened for root canal therapy.

Plan A+

In Network

Out of Network

Type 1 (Preventive)
Cleanings (4/year), Exams (4/year), Space Maintainers, Fluoride Applications, Sealants (through age 16), X-rays

100% of Network Fee

90% of U&C

Type 2 (Basic)
Simple Extractions and Fillings, Full or Partial Denture Repair, Complex Oral Surgery, Anesthesia (with surgical procedures)

90% of Network Fee

70% of U&C

Type 3 (Major)
Pontics (false tooth) and Bridges, Implants, Crown and Bridge Repair, Dentures and Partial Dentures, Crowns and Onlays, Periodontics (Gum Disease), Endodontics (Root Canals)

50% of Network Fee

50% of U&C

Deductible

$0

$50 per calendar year for Type 2 or 3

Maximum

$3,000 per calendar year

Preventive Plus

Type 1 services will not reduce available maximum

Allowance

Contracted fee

80th U&C for Type 1 and Type 2
70 th U&C for Type 3

Waiting Period

None
Dental Rewards Threshold: $750; Annual carryover: $400; Max carryover: $1,200
Orthodontics $1,000 adult and child coverage; 12 month waiting period for new enrollees
Vision Benefits Included
LASIK Benefits Included
SoundCare Benefits Included


Deductible: There is no deductible if you see a provider within the Ameritas Dental Network. Type 2 and Type 3 procedures have a combined $50 calendar year deductible when seeing a provider out of the network.

Maximum Benefit: The maximum dental benefit per calendar year is the most that will be paid for covered dental expenses incurred by each plan member. On Plan A+, the maximum dental benefit per calendar year is $3,000 (combined in and out of network).

Allowance: Network providers have contracted fees that are guaranteed to be within your plan allowance.

Type 1 and Type 2 out-of-network procedures are based on the 80th percentile of Usual and Customary (U&C), which means 8 out of 10 dentists’ charges in your specific area are at or below the plan allowance for a procedure.

Type 3 out-of-network procedures utilize the 70th percentile of U&C, which means 7 out of 10 dentists’ charges in your specific area are at or below the plan allowance for a procedure.

Preventive Plus: Preserve your annual maximum with Preventive Plus. Plan payments for covered Type 1 Preventive dental procedures are not deducted from your annual maximum benefit. This saves your annual maximum for Type 2 Basic or Type 3 Major procedures.

Dental Rewards: By visiting the dentist annually for preventive care, you can build up your annual maximum benefit to help pay for more expensive dental procedures in the future. File at least one dental claim during the benefit year and do not exceed the annual benefit threshold of $750. Preventive procedures apply to the annual threshold. You are then rewarded the following benefit year with $400 added to your $3,000 annual maximum. The maximum amount that can be carried over is $1,200.

At least one claim must be filed each benefit year or the annual maximum is reset to $3,000, at which point you can start rebuilding your Dental Rewards. Dental Rewards carry over between the plans if you change plans in the future.

Orthodontia: Coverage for orthodontic treatment is included on all plans. See the Orthodontia section below below for more details.

Vision Benefits: All employees participating in any of the group dental insurance plans will receive the vision benefit at no additional cost. See the Vision and LASIK page for more details

LASIK: With LASIK Advantage, you can receive benefits on a number of popular, well-established laser vision correction procedures. The LASIK plan is only available with Plan A+. See the Vision and LASIK page for more details.

SoundCare: With Soundcare, you can receive a wellness benefit that helps protect and preserve your ability to hear. The SoundCare plan is only available with Plan A+. You also can receive discounts on hearing tests and hearing aids through iHear. See the Hearing page for more details.

Plan A In Network Out of Network
Type 1 (Preventive)
Cleanings (4/year), Exams (4/year), Space Maintainers, Fluoride Applications, Sealants (through age 16), X-rays
100% of Network Fee 90% of U&C
Type 2 (Basic)
Simple Extractions and Fillings, Full or Partial Denture Repair, Complex Oral Surgery, Anesthesia (with surgical procedures)
90% of Network Fee 70% of U&C
Type 3 (Major)
Pontics (false tooth) and Bridges, Crown and Bridge Repair, Dentures and Partial Dentures, Crowns and Onlays, Periodontics (Gum Disease), Endodontics (Root Canals)
50% of Network Fee 50% of U&C
Deductible $0 $50 per calendar year for Type 2 or 3
Maximum $1,250 per calendar year
Preventive Plus Type 1 services will not reduce available maximum
Allowance Contracted fee 80th U&C for Type 1 and Type 2
70 th U&C for Type 3
Waiting Period None None
Dental Rewards Threshold: $500; Annual carryover: $250; Max carryover: $1,000
Orthodontics $1,000 child only (program started by age 17, finished by age 19); 12 month waiting period for new enrollees
Vision Benefits Included


Deductible: There is no deductible if you see a provider within the Ameritas Dental Network. Type 2 and Type 3 procedures have a combined $50 calendar year deductible when seeing a provider out of the network.

Maximum Benefit: The maximum dental benefit per calendar year is the most that will be paid for covered dental expenses incurred by each plan member. On Plan A, the maximum dental benefit per calendar year is $1,250 (combined in and out of network).

Allowance: Network providers have contracted fees that are guaranteed to be within your plan allowance.

Type 1 and Type 2 out-of-network procedures are based on the 80th percentile of Usual and Customary (U&C), which means 8 out of 10 dentists’ charges in your specific area are at or below the plan allowance for a procedure.

Type 3 out-of-network procedures utilize the 70th percentile of U&C, which means 7 out of 10 dentists’ charges in your specific area are at or below the plan allowance for a procedure.

Preventive Plus: Preserve your annual maximum with Preventive Plus. Plan payments for covered Type 1 Preventive dental procedures are not deducted from your annual maximum benefit. This saves your annual maximum for Type 2 Basic or Type 3 Major procedures.

Dental Rewards: By visiting the dentist annually for preventive care, you can build up your annual maximum benefit to help pay for more expensive dental procedures in the future. File at least one dental claim during the benefit year and do not exceed the annual benefit threshold of $500. Preventive procedures apply to the annual threshold. You are then rewarded the following benefit year with $250 added to your $1,250 annual maximum. The maximum amount that can be carried over is $1,000.

At least one claim must be filed each benefit year or the annual maximum is reset to $1,250, at which point you can start rebuilding your Dental Rewards. Dental Rewards carry over between the plans if you change plans in the future.

Orthodontia: Coverage for orthodontic treatment is included on all plans. See the Orthodontia section below below for more details.

Vision Benefits: All employees participating in any of the group dental insurance plans will receive the vision benefit at no additional cost. See the Vision and LASIK page for more details

Hearing Benefits: You, and your friends and family, can order a hearing test and hearing aids online through iHear. See the Hearing page for more information.

Plan B In and Out of Network
Type 1 (Preventive)
Cleanings (2/year), Exams (2/year), Space Maintainers, Fluoride Applications,
100% U&C
Type 2 (Basic)
Simple Extractions and Fillings, Full or Partial Denture Repair, Sealants (through age 16), X-rays
Benefits based on the schedule for Plan B
Type 3 (Major)
Pontics (false tooth) and Bridges, Crown and Bridge Repair, Dentures and Partial Dentures, Crowns and Onlays, Periodontics (Gum Disease), Endodontics (Root Canals), Complex Oral Surgery, Anesthesia (with surgical procedures)
Benefits based on the schedule for Plan B
Deductible $100 per calendar year for Type 2 or 3
Maximum $1,000 per calendar year
Waiting Period None
Dental Rewards Threshold: $500; Annual carryover: $250; Max carryover: $1,000
Orthodontics $1,000 child only (program started by age 17, finished by age 19); 12 month waiting period for new enrollees
Vision Benefits Included


Deductible: There is no deductible for Type 1 procedures. Type 2 and Type 3 procedures have a combined $100 calendar year deductible.

Maximum Benefit: The maximum dental benefit per calendar year is the most that will be paid for covered dental expenses incurred by each plan member. On Plan B, the maximum dental benefit per calendar year is $1,000 (combined in and out of network).

Allowance: This plan utilizes the 50th percentile of Usual and Customary for Type 1 procedures, which means 5 out of 10 dentists’ charges in your specific area are at or below the plan allowance for a procedure.

Type 2 and Type 3 procedures are reimbursed based on a set fee, or schedule. See the full list of covered Type 2 and Type 3 procedures and their covered amounts.

Dental Rewards: By visiting the dentist annually for preventive care, you can build up your annual maximum benefit to help pay for more expensive dental procedures in the future. File at least one dental claim during the benefit year and do not exceed the annual benefit threshold of $500. Preventive procedures apply to the annual threshold. You are then rewarded the following benefit year with $250 added to your $1,000 annual maximum. The maximum amount that can be carried over is $1,000.

At least one claim must be filed each benefit year or the annual maximum is reset to $1,000, at which point you can start rebuilding your Dental Rewards. Dental Rewards carry over between the plans if you change plans in the future.

Orthodontia: Coverage for orthodontic treatment is included on all plans. See the Orthodontia section below for more details.

Vision Benefits: All employees participating in any of the group dental insurance plans will receive the vision benefit at no additional cost. You also receive discounts on LASIK procedures through an EyeMed provider. See the Vision and LASIK page for more details.

Hearing Benefits: You, and your friends and family, can order a hearing test and hearing aids online through iHear. See the Hearing page for more information.

Overview: Orthodontia coverage is available on each dental plan. Plan A and Plan B offer coverage for children only. Plan A+ provides orthodontia coverage for adults as well as children. Plan payments will begin automatically to the party assigned on the claim form. The payout is made in equal quarterly installments not to exceed two years.

  Plan A+ Plan A Plan B
Coverage type Adults and children Children only Children only
Amount the plan pays 50% 50% 50%
Lifetime maximum (per person) $1,000 $1,000 $1,000
Waiting period 12 months
New enrollees only
12 months
New enrollees only
12 months
New enrollees only


Orthodontic Treatment: Orthodontic treatment means the movement of teeth by means of active appliances to correct the position of maloccluded or malpositioned teeth.

Treatment program: Treatment program means an interdependent series of orthodontic services prescribed by a physician to correct a specific dental condition. A program will start when the active appliances are inserted. A program will end when the services are done, or after eight calendar quarters starting with the day the appliances were inserted, whichever is earlier.

Please note: Plan A+ includes coverage for both adults and children. On Plan A and Plan B, the orthodontia benefit is available up until the dependent child’s 19th birthday. Since the average orthodontic program is 24 months, the child needs to be banded by their 17th birthday to receive the full 8 quarters of benefit.

Expenses: An expense is incurred:
a. at the end of every quarter (three-month period) of a treatment for a person who pursues an orthodontic program, but not beyond the date the treatment ends, or 

b. at the time the service is rendered for a person who incurs covered expenses but does not pursue a treatment program. 


Benefit Calculation: Benefits will be payable when a covered expense is incurred. The covered expenses are based on the estimated cost of the patient’s treatment program. Payments are pro-rated by quarter (three month periods) over the estimated length of the program, but not for more than eight quarters, and multiplied by the orthodontic benefit percentage (50%). The last quarterly payment for a treatment may be changed if the estimated and actual cost of the treatment differs.

Ineligible Orthodontia Expenses: Covered expenses exclude and no benefits will be paid for expenses incurred:
1. for an orthodontic treatment program which began on or after an insured’s 17th birthday. Not applicable to Plan A+. 

2. for a treatment program which began before the insured became covered for Orthodontic Expense Benefits. 

3. after the individual’s insurance for orthodontic benefits terminates. 

4. for orthodontic treatment started prior to 12 month waiting period is satisfied for new enrollees. In this case, benefits will be prorated and may results in the full lifetime maximum not being released.

Each plan member is free to visit any provider they choose, including your current dentist, regardless if they are in- or out-of-network. And family members do not have to see the same dentist. When you visit an in-network dentist your out-of-pocket expenses are generally 20-40 percent lower and there are no claim forms to complete. Find an Ameritas Dental Network Provider.

There are many online services available with your Ameritas dental and vision benefits. Many of these are available in your secure member account.
Dental Health Report Card: See your dental health score
Dental Cost Estimator: Find the average cost in your area for dental services
ID Cards: Both your dental and vision ID cards are available through your secure member account
Worldwide Assistance: Receive provider referral assistance when traveling outside the U.S.
Electronic Explanation of Benefits (EOB): Sign up to receive your explanation of benefits statements electronically

After enrolling for coverage, log in to your secure member account (NY) to access these services.

View our dental videos and articles about wellness, a healthcare glossary and more at ameritasinsight.com

Claims, benefit, and provider network questions: group@ameritas.com 800-659-5556 Monday-Thursday 8am-1am and Friday 8am to 7:30pm (ET)

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