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PrimeStar® Lite
Plan Type PPO
Coinsurance The In-network allowances are:
Preventive (Type 1) 100%
Basic (Type 2) Year 1: 50%; Year 2+: 80%
Major (Type 3) Year 1: 10%; Year 2+: 20%
The Out-of-network allowances are:
Preventive (Type 1) 70%
Basic (Type 2) Year 1: 25%; Year 2+: 40%
Major (Type 3) Year 1: 5%; Year 2+: 10%
Please see plan brochure for full coinsurance information.
Deductible $50 (applies to basic and major services combined per benefit year)
Annual Maximum Benefit Graded - $750 first year, $1,500 years 2+
Type 1 Preventive procedures are not deducted from the plan's annual maximum benefit. This saves all of the annual benefit to help pay for more expensive Type 2 and 3 procedures.
Office Visit
Find Dentists 		N/A
Primary Benefits
Teeth Cleanings In-network: 100%
Out-of-network: 70%
2 per year
Restorative Dentistry/Fillings In-network: Year 1: 50%; Year 2+: 80%
Out-of-network: Year 1: 25%; Year 2+: 40%
Oral Surgery In-network: Year 1: 10%; Year 2+: 20%
Out-of-network: Year 1: 5%; Year 2+: 10%
Extractions In-network: Year 1: 10%; Year 2+: 20%
Out-of-network: Year 1: 5%; Year 2+: 10%
X-Rays Bitewing X-rays:
In-network: Year 1: 50%; Year 2+: 80%
Out-of-network: Year 1: 25%; Year 2+: 40%
All Other X-rays:
In-network: Year 1: 10%; Year 2+: 20%
Out-of-network: Year 1: 5%; Year 2+: 10%
Crowns In-network: Year 1: 10%; Year 2+: 20%
Out-of-network: Year 1: 5%; Year 2+: 10%
Root Canals In-network: Year 1: 10%; Year 2+: 20%
Out-of-network: Year 1: 5%; Year 2+: 10%
Periodontics In-network: Year 1: 10%; Year 2+: 20%
Out-of-network: Year 1: 5%; Year 2+: 10%
Dentures In-network: Year 1: 10%; Year 2+: 20%
Out-of-network: Year 1: 5%; Year 2+: 10%
Topical Fluoride In-network: Year 1: 50%; Year 2+: 80%
Out-of-network: Year 1: 25%; Year 2+: 40%
(under age 16)
Sealant In-network: Year 1: 50%; Year 2+: 80%
Out-of-network: Year 1: 25%; Year 2+: 40%
(under age 16)
Bridges In-network: Year 1: 10%; Year 2+: 20%
Out-of-network: Year 1: 5%; Year 2+: 10%
Endodontics In-network: Year 1: 10%; Year 2+: 20%
Out-of-network: Year 1: 5%; Year 2+: 10%
Additional Information
A.M. Best Rating N/A as of 04/23/2025
Electronic Signature for Application Available Yes
Details and documents about this plan
View Plan Brochure The carrier has not provided a separate document for Exclusions and Limitations.

Important notices and disclaimers

  • The information shown here is a summary of benefits for informational purposes only. Review the official plan documents (such as evidence of coverage, plan brochure, or insurance policy) for a detailed description of coverage benefits, limitations, and exclusions. Only the terms and conditions of coverage benefits listed in the policy are binding.
  • The benefits listed may be contingent on your use of physicians, hospitals, dentists and services within the specific insurance company's provider network.
  • The Copayment, Deductible, and Coinsurance amounts are your share of the costs for covered benefits. These amounts are subject to change.
  • The quotes or rates shown above are estimates only. Your premium is subject to change based on your medical history (pursuant to state law of residence), the underwriting practices of the insurance company, the optional benefits you selected, if any, and other relevant factors, such as changes in rates which take effect before your requested effective date. The insurance company always determines your actual premium. Insurance companies reserve the right to change the terms of a policy upon proper notification.

Carrier specific notices, disclaimers and fees

  • Ameritas Life Insurance Corp. - Underwritten by Ameritas Life Insurance Corp. ¦ 5900 O Street Lincoln, NE 68510
    This is not a certificate of insurance or guarantee of coverage. Plan designs may not be available in all areas and are subject to individual state regulations. This piece is not for use in New Mexico. This information is provided by Ameritas Life Insurance Corp. (Ameritas Life). Dental, vision and hearing care products (9000 Rev. 03-16 for Group and 9000 Rev. 10-22 for Individual, dates may vary by state) are issued by Ameritas Life. The Dental and Vision Networks are not available in RI. In Texas, our dental network and plans are referred to as the Ameritas Dental Network. Ameritas, the bison design and "fulfilling life" are service marks or registered service marks of Ameritas Life, affiliate Ameritas Holding Company or Ameritas Mutual Holding Company. © 2024 Ameritas Mutual Holding Company.