1. Egyptian Area Schools Employee Benefit Trust Group #010-350813
Highlight of Dental Options
Hello, this presentation will provide an overview of the dental
benefits offered through the Egyptian Area Schools Employee Benefit Trust. We will
share information with you about Ameritas and touch on some of the plan
details available to you and your covered dependents.
By Ameritas group division

2. Employees can choose from two plans:
High Plan or
Low Plan
Employees have the choice of two dental plans which allows you to pick the benefits and rate that best fits your needs.

3. Under either the High Plan or the Low Plan
Employees can take single coverage or add dependent coverage
Dependents receive the same plan chosen by the employee
Employees can switch between plans at the annual election period
Both plans allow employees to select single coverage or add coverage for eligible dependents. At the next annual election period, you can switch between plans without penalty.

4. See the highlight of the plan options
Now let’s cover some of the highlights under both plans.

5. High Plan Highlight Orthodontia – for children 50% up to plan maximum
Type 1 - Preventive procedures
100% (exams, cleanings, x-rays, child fluoride, etc.)
Type 2 - Basic procedures
80% (extractions, fillings, sealants, root canals, treatment of gum disease, oral surgery, etc.)
Type 3 - Major procedures
50% (crowns, crown repairs, dentures, bridges, implants, etc.)
Orthodontia – for children
50% up to plan maximum
Under the High plan, Type 1 Preventive procedures, such as exams, cleanings, and fluoride are considered at 100% of U&C.
Type 2 Basic procedures like extractions, filings, sealants, treatment of gum disease, and oral surgery are considered at
80% of the maximum procedure allowance.
The High Plan includes coverage for Type 3 Major procedures that includes treatment of crowns, dentures, bridges, and implants. These procedures are considered at 50% of the maximum procedure allowance.
Orthodontic benefits for are available for children on the High Plan. Orthodontia is reimbursed at 50% up to the plan maximum.
Please note the coinsurance levels shown are reimbursed based on “U&C” or the “maximum procedure allowance” depending on the procedure type.
Type 1 Preventive procedures are reimbursed based on the 90th U&C for the dentist’s zip code, meaning the 9 out of 10 dentist’s charges will fall within the amount Ameritas allows for Preventive procedures.
Type 2 Basic and Type 3 Major procedures are reimbursed on the Maximum Procedure Allowance which is established according to the median dentist charges in the zip code where serves are provided.

6. High Plan Highlight Deductible Maximum Orthodontia
Type 1 Procedures $10 per visit
Type 2 & 3 Combined $50 Per Calendar Year
Maximum deductible: three (3) family members
Orthodontia None
Maximum
Annual Maximum Per Member $1,500
Orthodontia
Lifetime Maximum Per Child $1,000
The High plan has no deductible on Type 1 Preventive procedures and a $50 calendar year deductible on Type 2 and 3 procedures combined. When three family members have satisfied their deductible, no further deductible is taken for the other family members for the rest of that year. There is no deductible on orthodontic benefits.
The High plan has a dental maximum benefit of $1,500 per member. An additional $1,000 lifetime benefit is available for orthodontic benefits one time per lifetime per child.

7. High Plan Highlight Added notes about Orthodontia . . .
Available up to age 19
Start by age 17 to receive the full orthodontic maximum
Let’s take a moment and talk the orthodontic benefits
-- Orthodontic benefits are available on the High Plan for children up to age Since most orthodontic programs take two years to complete, the program needs to start by age 17 for the member to get the full orthodontic maximum benefit.
-- For orthodontic programs that were covered under an insurance plan prior to your Ameritas effective date, and are in progress, Ameritas will provide takeover benefits that coordinate benefits between the old plan and the new plan to make sure members get the remaining maximum benefit. For example, if the old plan had paid $500 toward your orthodontic treatment plan, you would still be eligible for an additional $500 under the
Ameritas plan. Ameritas reimburses orthodontic payments quarterly.

8. High Plan Highlight Ameritas Rewards!
Utilize unused dental maximum to carryover towards dental benefits
Or carryover up to $100 for additional orthodontia coverage
Accumulate unlimited maximum dental carryover amount.
Must submit dental claim during a benefit year or all accumulated rewards are lost!
A member is eligible to earn rewards again the next year.
Benefit Threshold
$750
Dental benefits received for the year cannot exceed this amount
Annual Carryover Amount
$250
Ameritas Rewards amount is added to the following year's maximum
Annual PPO Bonus
$150
Additional bonus is earned if the member sees a network provider
Maximum Carryover
Unlimited
Maximum possible accumulation for Dental Rewards and PPO Bonus combined
The High Plan includes a plan enhancement called Ameritas Rewards! This feature allows members to utilize some of their unused annual dental maximum in one year to carry over into the next year.
Here is how it works If a person uses $750 or less in dental benefits in one year, they can carry over $250 to add to the following year’s maximum dental benefit. If a PPO provider was used, an additional $150 can be carried over to the following year.
Let’s do the math. The High plan includes a $1500 maximum benefit per person. If less than $750 is used, and the person carries over $250 to the following year, their maximum benefit available the next year is $ An additional $150 can be carried over if a PPO provider was used, which would make the person’s maximum benefit $1900.
The covered person can continue carrying over a portion of their maximum year after year. There is no limit to the amount that can be accumulated.
For covered children, a higher annual dental maximum benefit may not be needed. However Ameritas Rewards can be used for orthodontic programs. If a covered child uses less than $750 of their annual dental maximum, rather than carrying over their unused dental maximum for a higher dental maximum the next year, the covered child can carryover up to $100 to be for additional orthodontia coverage.
Remember that the covered person must submit at least one claim during the benefit, or the carryover amount is lost, and the person begins to earn rewards again the next year.

9. Low Plan Highlight Type 1 - Preventive procedures
80% (exams, cleanings, x-rays, child fluoride, etc.)
Type 2 - Basic procedures
70% % (extractions, fillings, sealants, root canals, treatment of gum disease, oral surgery, etc.)
Type 3 - Major procedures (not covered under this plan)
Orthodontia (not covered under this plan)
Under the Low plan, Type 1 Preventive procedures, such as exams, cleanings, and fluoride are considered at 80% of U&C.
Type 2 Basic procedures like extractions, filings, sealants, treatment of gum disease, and oral surgery are considered at
70% of the maximum plan allowance.
Under this plan, there is no Major or Orthodontic benefits.
Like the high plan, you will note that the coinsurance levels shown are reimbursed based on “U&C” or the “maximum plan allowance” depending on the procedure type.
Type 1 Preventive procedures are reimbursed based on the 90th U&C for the dentist’s zip code, meaning the 9 out of 10 dentist’s charges will fall within the amount Ameritas allows for Preventive procedures.
Type 2 Basic are reimbursed on the Maximum Plan Allowance which is established according to the median dentist charges in the zip code where serves are provided.

10. Low Plan Highlight Deductible Maximum Type 1 Procedures $10 per visit
Type 2 Procedures $50 Per Calendar Year
Maximum deductible: three (3) family members
Maximum
Annual Maximum Per Member $750
There is no deductible for Preventive procedures on the Low Plan. If you or a covered dependent has a procedure related to Basic services, a $50 deductible will be applied. When three family members have satisfied their deductible, no further deductible is taken for the other family members for the rest of that year.
The dental maximum benefit on the Low plan for each enrolled person is $750 every calendar year.

11. Low Plan Highlight New Plan Feature. . . . Dental Rewards!
Utilize unused dental maximum to carryover towards dental benefits
Accumulate up to $500 to carryover
Must submit dental claim during a benefit year
or all accumulated rewards are lost!
A member is eligible to earn rewards again the next year.
Benefit Threshold
$250
Dental benefits received for the year cannot exceed this amount
Annual Carryover Amount
$125
Ameritas Rewards amount is added to the following year's maximum
Annual PPO Bonus
$50
Additional bonus is earned if the member sees a network provider
Maximum Carryover
$500
Maximum possible accumulation for Dental Rewards and PPO Bonus combined
The Low Plan includes a plan enhancement called Dental Rewards! This feature allows members to utilize some of their unused annual dental maximum in one year to carry over into the next year.
Here is how it works If an enrolled person uses $250 or less in dental benefits in one year, they can carry over $125 to add to the following year’s maximum benefit. If a PPO provider was used, an additional $50 can be carried over to the following year.
Let’s do the math. The Low plan includes a $750 maximum benefit per person. If less than $250 is used, and the person carries over $125 to the following year, their maximum benefit available the next year is $ An additional $50 can be carried over if a PPO provider was used, which would make the person’s maximum benefit $925.
That person can keep carrying over a portion of their maximum until the carryover amount totals $500.
Remember that the covered person must submit at least one claim during the benefit, or the carryover amount is lost, and the person begins to earn rewards again the next year.

12. PPO available under both plans
Freedom to use any licensed dentist
Coverage is the same whether you go in network or out of network
A great feature about both the High and the Low plans is that you have access to Ameritas’ PPO network.
Do you have to use a PPO provider? No. Under both the High and Low Plans, the member and their covered dependents have the choice to utilize any licensed dental provider. There is no difference in coinsurance, deductible or maximums for using an out of network provider.
From the dentist’s perspective, both network and out of network providers have the same access to Ameritas’ provider service, including access to benefits, claims submittal can be via mail, fax, or electronic submittal, submitting pretreatment estimates and receiving payment directly.
The difference is that out of network providers have not agreed to offer a PPO discount. So, often times, a member will experience lower out of pocket expenses when visiting a PPO network provider because of contracted fees.
In addition to the potential savings, members can be assured that the Ameritas PPO providers have gone through a stringent credentialing and quality assurance process. And PPO providers provide added services such as filing claims on behalf of the member.

13. Filing a claim is easy! PPO Providers will submit the claims for you!
You or your out-of-network provider may file the claim via mail, fax or
Filing claims is easy!
If a PPO dentist is used, the provider will file the claim for you.
If you see an out of network provider, filing claims is still easy. Simply complete the top portion of the claim form with your name and contact information then attach the bill or summary of services from the dentist. Some dentist’s even provide a generic claim form which we accept as well.
You can mail the claim or use fax or .
Our claim processing is very fast and typically averages less than 10 days to process.

14. Questions about the dental plans or a claim?
Toll free
Available 7:00 a.m. CST – 12:00 midnight Monday – Thursday
and 7:00 a.m. CST – 6:30 p.m. on Friday.
OR go online for Frequently Asked Questions and more at:
If you have questions about the plans or a specific claim, please call our toll free number. If you visit our website, you will find forms, benefit highlights, Frequently Asked Questions, and more!

15. Thank you!
Thank you for taking the time to view this dental and vision benefit presentation.
Ameritas appreciates this opportunity to be of service.