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Group Enrollment / Change or Waiver Form COBRA - If the individual is a continuee: Qualifying Event Date of Event POLICY AND DIV. # 010NAME AND ADDRESS OF EMPLOYER (Policyholder) 1. TO ENROLL DENTAL.

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Ameritas PrimeStar vision insurance plans all offer next-day coverage, no waiting periods, and no enrollment fees. Choose from plans that feature the VSP or EyeMed vision networks. All plans include coverage for eye exams and eyewear such as glasses or contact lenses.

Your Dentist should call our claims department at (800) 653-4427, and use our automated benefit system, which will fax your benefit information back to him/her with a quick response. Your dentist should mail claims to: Ameritas Life Insurance Corp. Most dentists will use their own forms and file the claim for you.

Dental Providers Call us at: 800-755-8844. Fax us at: 402-467-7339. Email us at: providerrelations@ameritas.com.

For help, call us at the number listed on your ID card or 877-233-3797. For more help call the CA Dept. of Insurance at 800-927-4357.

The Ameritas Dental Network is the second largest PPO in the state of Florida, so you have convenient access to both general and specialist dental providers. You are free to visit any provider you choose! Your out-of-pocket costs may be 25-50% lower when visiting a network provider.

Ameritas provides dental and vision insurance to more than 11 million people nationwide.

Silver and Gold Plans Basic procedures include fillings and extractions, while major services include root canal procedures and crowns.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232