View full plan details at ambadentalvision.com/ILRTA. This highlight is not a certificate of insurance or a guarantee of coverage. Premium rates may change upon renewal and can be adjusted for the entire group or a specific class. A class is defined in the group policy. Benefits are subject to change upon agreement between the carrier and the participating organization. The policy is renewable at the option of the insured.
*In most cases you will receive the greatest out of pocket savings if you see an in-network PPO provider. For the Premier Plan, Out-of-Network Reimbursement percentages for Type 1, Type 2 & Type 3 are based on the usual and customary charges and Type 4 services are limited to Ameritas’ prevailing contracted provider fees. The Standard Plan Out-of-Network reimbursement percentages are also limited to Ameritas’ prevailing contracted provider fees. All services are subject to limitations and exclusions. The master policy is governed by the laws of the state of Illinois.
***Plan pays 80% coverage for Type 2 services after the first year, and 90% coverage for Type 2 services after the second year. To increase the coinsurance level, you must file at least one claim per calendar year.