( ) PEARLPLANS. group dental insurance. It s smart to put your money where your mouth is. FOR GROUPS OF % COVERAGE OF PREVENTIVE SERVICES

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1 1 ( ) PEARLPLANS group dental insurance It s smart to put your money where your mouth is. FOR GROUPS OF % COVERAGE OF PREVENTIVE SERVICES CHOICE OF PLANS FLEXIBLE OPTIONS TO REDUCE COST FLEXIBLE PARTICIPATION REQUIREMENTS /08

2 The BRILLIANCE of our plans. INCENTIVE PLAN The EssentialDental program has been implemented in this plan to offer benefits and services used most. This is the ideal plan for groups who want to contain costs but still cover the essentials plus a few extras. Plan members visit a dentist once during the first calendar year and benefits automatically increase the following year for Type 2 and Type 3 Care. The Maximum Allowable Charge (MAC) established with the Ameritas Participating Provider Organization often lowers members out-of-pocket expenses if they use an in-network provider. FEATURES AND BENEFITS THE PLANS AT A GLANCE TYPE 1 PREVENTIVE CARE TYPE 2 BASIC CARE TYPE 3 MAJOR CARE DEDUCTIBLE ANNUAL BENEFIT MAXIMUM Covered at 100% of allowed amount Covered at 50% of allowed amount in first calendar year, and at 80% of allowed amount thereafter as long as any covered expense is incurred in previous year Covered at 25% (after elimination period for groups of 3-9) of allowed amount in first calendar year, and at 50% of allowed amount thereafter as long as any covered expense is incurred in previous year Not available $50 annual $1,000 Employers may increase the annual maximum for their insureds by adding Dental Rewards DENTAL ELIMINATION PERIOD 12 Months on Type 3 Care, waived on groups of PARTICIPATION REQUIREMENTS 100% for groups of % for groups of Employees waiving because they are covered under another dental plan do not count towards participation Three great plan enhancements 1. All plans have a voluntary option for groups of See Underwriting Guidelines for more details. 2. Discounted fees are available if dental participation is tied to your medical plan. 3. Dental Rewards. Qualifying insureds rollover a portion of their unused annual maximum. Ask your sales consultant for more details.

3 STEP-UP PLAN Simply put, dental benefit plans save money. The Institute of Medicine estimates dental plans save employers and employees $4 billion each year through the emphasis on prevention, early detection and treatments. Dental insurance is not an expense; it is an investment in the health and productivity of your employees. And, it s a benefit more and more employees expect. This plan offers a full array of coverage with lots of flexibility. Orthodontics is optionally available for groups with lives. The periodontics/endodontics in Type 2 is optional for groups of lives or groups with 3-9 lives that elect and qualify for takeover benefits. The Step-Up plan utilizes the 90th percentile of U&C, meaning that 9 out of 10 dentists in a specific area charge at or below the plan allowance for a procedure. To lower rates, the group can elect to have benefits paid according to the Maximum Allowable Charge (MAC) established with the Ameritas Participating Provider Organization, which often lowers members out-of-pocket expenses if they use an in-network provider. FOR GROUPS OF 3-9 FOR GROUPS OF FEATURES AND BENEFITS THE PLANS AT A GLANCE TYPE 1 PREVENTIVE CARE TYPE 2 BASIC CARE TYPE 3 MAJOR CARE DEDUCTIBLE ANNUAL BENEFIT MAXIMUM Covered at 100% of allowed amount Covered at 80% of allowed amount Covered at 50% of allowed amount Not available Choice of $25 per quarter or $50 annual Choice of Employers may increase the annual $1,000 maximum for their insureds by or $1,500 adding Dental Rewards Covered at 100% of allowed amount Covered at 80% of allowed amount Covered at 50% of allowed amount 50% (no deductible), $1,000 lifetime max, 12 month elimination period Choice of $25 per quarter or $50 annual Choice of Employers may increase the annual $1,000 maximum for their insureds by or $1,500 adding Dental Rewards DENTAL ELIMINATION PERIOD 12 Months on Type 3 Care None PARTICIPATION REQUIREMENTS 100% Employees waiving because they are covered under another dental plan do not count towards participation 75% Employees waiving because they are covered under another dental plan do not count towards participation

4 DUAL CHOICE PLAN Dual Choice gives employers an affordable way to offer their employees the freedom to select a plan that best meets their needs. All of the Dual Choice plans include EssentialDental, a cost-effective design that covers the dental services people generally use most. Here s how Dual Choice works: The employer selects two plan options one of the two Standard plan options listed below and one of the two Enhanced plan options. The employees then make their selection between the employer's Standard and Enhanced plan options. Employees who want richer coverage can choose the Enhanced plan. All plans include Dental Rewards, which lets qualifying insureds rollover a portion of their unused annual maximum if they meet specified guidelines. STANDARD OPTION ENHANCED OPTION Plan 1 Plan 2 Plan 1 Plan 2 FEATURES AND BENEFITS THE PLANS AT A GLANCE TYPE 1 PREVENTIVE CARE TYPE 2 BASIC CARE TYPE 3 MAJOR CARE DEDUCTIBLE ANNUAL BENEFIT MAXIMUM 100% of allowed amount 100% of allowed amount 80% of allowed amount 80% of allowed amount Not available Schedule $50 Calendar Year, $50 Calendar Year, Waived on Type 1 Waived on Type 1 $750 $1, % of allowed amount 100% of allowed amount 80% of allowed amount 80% of allowed amount 50% of allowed amount 50% of allowed amount $50 Calendar Year, $100 lifetime Type 2, Waived on Type 1 $50 Calendar year Type 3 $1,500 or $2,000 $1,500 or $2,000 DENTAL ELIMINATION PERIOD Not Available 12 Months on Type 3 Care No Benefits waived on groups of Months on Type 3 Care 12 Months on Type 3 Care waived on groups of 10+ waived on groups of 10+ PARTICIPATION REQUIREMENTS 100% for groups of 3-9, 100% for groups of 3-9, 75% for groups of % for groups of % for groups of 3-9, 100% for groups of 3-9, 75% for groups of % for groups of * Employer must select eye care or orthodontics benefits for both plan options, or reject eye care or orthodontics benefits for both plan options. * Product availability varies by state. * Standard Option plan 2 utilizes the 90th percentile of U&C, which means that 9 out of 10 dentists in a specific area charge at or below the plan allowance for a procedure. Enhanced Option Plan 1 and Plan 2 can be 90th U&C, 75th U&C, which means that 7.5 out of 10 dentists in a specific area charge at or below the plan allowance for a procedure, or MAC. Standard Option Plan 1 is MAC. * Employees/dependents may switch from the Standard to the Enhanced plan, or vice versa, on the group s renewal effective date.

5 WHAT KINDS OF SERVICES ARE COVERED? 1] TYPE 1 [PREVENTIVE CARE] Cleanings, exams, fluorides: all plans Bitewings: (except Dual Choice Standard Plan 2 covered in Type 2) Full-mouth X-rays: (except Dual Choice Standard Plan 2 covered in Type 2) Single tooth X-rays: Step-Up plan only (not covered for Incentive and Dual Choice plans) 2] TYPE 2 [BASIC CARE] Sealants: all plans Extractions - All extractions for Step-Up plan - Simple extractions for Incentive and Dual Choice plans Amalgams: all plans 3] TYPE 3 [MAJOR CARE] Gold, acrylic, and porcelain fillings, onlays, or crown restorations: all plans Partial or full dentures: all plans Bridgework: all plans Surgical extractions for Incentive and Dual Choice Plans 4] PERIODONTICS (gum disease care) and ENDODONTICS Step-Up Plan Type 3: case size 3-9 non-takeover Type 2 or Type 3: case size 3-9 with takeover and 10+ Incentive Plan Type 3: case size 3-9 non-takeover Type 2 or Type 3 case size 3-9 with takeover and 10+ Dual Choice Standard Plan 1 Non-surgical procedures covered in Type 2 for all case sizes 3-9 with takeover and 10+ Surgical procedures not covered Dual Choice Standard Plan 2 and Enhanced Plan 1 Non-surgical procedures covered in Type 2 for case sizes 3-9 with takeover and 10+ Non-surgical procedures covered in Type 3 for 3-9 non-takeover Surgical procedures covered in Type 3 for all case sizes Dual Choice Enhanced Plan 2 Non-surgical procedures covered at 65% for all case sizes Surgical procedures covered in Type 3 for all case sizes WHAT ALLOWANCES IMPACT MY PLAN? 1] USUAL & CUSTOMARY (U&C) Benefits for a given dental procedure are calculated according to the U&C charge for that procedure within a particular ZIP Code area. Pearl Plans utilize the 90th or 75th percentile of U&C. This means that 9 out of 10 or 7.5 out of 10 dentists in a specific area charge at or below the plan allowance for a procedure. 2] MAXIMUM ALLOWABLE CHARGE (MAC) A discounted dental procedure charge that is derived from the array of provider charges within a particular ZIP Code area. MAC fees are associated with a PPO plan and are accepted by participating providers. 3] SCHEDULE ALLOWANCES Pre-defined benefit per procedure for the area in which the plan is issued. DENTAL PLAN LIMITATIONS LIMITATIONS. Covered expenses will not include, and no benefits will be payable for expenses incurred: 1] Before satisfying elimination period 2] In the first 12 months except for cleaning, exam, and fluoride when a person is a late entrant 3] For cosmetic purposes 4] To replace prosthetics, onlays and crowns: within 5 years for Step-Up Plan; within 8 years for Incentive Plan; within 8 years for Dual Choice Plan 5] For Initial placement of prosthetics unless extraction while insured 6] For any procedure started prior to coverage effective 7] For any procedure started after coverage terminates 8] To replace lost or stolen appliances 9] For appliances, restorations or procedures that alter vertical dimension, restore or maintain occlusion, or splint or replace tooth structure lost as a result of abrasion or attrition 10] For any procedure not shown on Table of Dental Procedures 11] For education or training 12] For the completion of claim forms 13] For orthodontics except if elected for Step-Up Plan or Dual Choice Plan 14] For sealants not applied to permanent molars, or over age 16 in Step-Up Plan and over age 14 in Incentive and Dual Choice Plans, or reapplied within three years for Step-Up Plan, or reapplied for Incentive and Dual Choice Plans 15] For injury from work 16] If eligible for Worker s Compensation 17] For charges for which insured is not liable 18] For services not recommended by physician or not necessary 19] Due to war or any act of war, declared or not 20] If payment is not legal where insured resides when incurred ORTHODONTIC LIMITATIONS LIMITATIONS. Covered Expenses will not include and no benefits will be payable for expenses incurred: 1] For a program which was begun before the insured became covered under this section 2] Before the insured has been insured under this section for at least 12 consecutive months 3] In any quarter of a program if the insured was not covered under this section for the entire quarter 4] After the insured's insurance under this section terminates 5] Because of an injury arising out of, or in the course of, any work for wage or profit 6] By an insured because of a sickness for which he or she is eligible for benefits under any Worker's Compensation act or similar laws 7] For charges which the insured is not legally required to pay or which would not have been made had no insurance been in force 8] For services which are not recommended by a physician or which are not required for necessary care and treatment 9] Due to war or any act of war, declared or not 10] By an insured if payment is not legal where the insured is living when the expenses are incurred 11] In the first twelve months that a person is insured if the person is a late entrant Pearl Plans provide optional access to the Vision Service Plan (VSP) Network to maximize cost savings. By going to a VSP member doctor, each covered person receives: 1] One eye exam per calendar year covered at 100% 2] 20% discount on glasses and spectacle lens options 3] 15% discount on professional services associated with contact lenses 4] No up-front paperwork 5] Laser VisionCare SM VSP has arranged for members to receive discounts that can add up to hundreds of dollars in savings on plan-approved LASIK or PRK laser correction surgery when coordinated by a VSP doctor and performed at a contracted laser surgery center Insureds also have the option of choosing their own eye care provider. Benefits for service from a non-vsp provider are paid on a scheduled amount per area. For additional information about eye care benefits, including a list of network doctors, call VSP Customer Service at or visit them online at * Refer to Underwriting Guidelines insert (#15332UW 8/08) for eligibility, participation and takeover requirements This brochure is a general overview highlighting the features of our Pearl Plans. A complete description is in the certificate of insurance issued to each employee.

6 For more information visit us at Marketed and Administered by: HealthPlan Services is a leading managed health care services company, providing distribution, enrollment, billing and collection, claims administration, and risk management services for health care payors and providers. HPS customers include insurance companies, HMOs and other managed care organizations, and organizations with self-funded health care plans. Based in Tampa, Florida, the company serves over 100,000 businesses, covering over 1.6 million members in the United States. Insured by: Ameritas Group offers the flexible, affordable dental and eye care coverage that today s employers demand. Highlights include superior customer service, choice of plan designs, Dental Rewards maximum rollover, quality PPO network, accurate and fast claims payment, and a parent company with consistently high ratings for financial strength and stability from independent insurance industry analysts HealthPlan Services. Ameritas, the bison symbol, EssentialDental, Pearl Plans and Dental Rewards are registered service marks of Ameritas Life Insurance Corp. All are used with permission. Ameritas Group, a division of Ameritas Life Insurance Corp. (Ameritas Life), a UNIFI Company, offers group dental and eye care products nationwide. In New York, insurance products are offered through First Ameritas Life Insurance Corp. of New York (First Ameritas). Certain plan designs may not be available in all areas. In Arizona, exclusions and limitations must accompany plan highlights.the master group insurance policy providing coverage is governed by the laws of Rhode Island.Some states require that brokers/producers be appointed with Ameritas Group before soliciting its products. To become appointed with Ameritas Group call Ameritas Group s dental and eye care tailored products (Form 9000 Ed ) and trust products (Form 9000-Trust Ed ) are issued by Ameritas Life.