Forms & Disclosures

When accessing or downloading online forms, you agree to release, indemnify and hold harmless Ameritas Life Insurance Corp. and/or its subsidiaries for any damage or liability encountered from using these forms. Please remember to keep only the most current Ameritas forms on file.

Forms

Disclosures

The Iowa Supreme Court has determined that Iowa law does not allow dental insurers to set maximum fees on services that the insurer does not cover or reimburse. As your insurer or administrator, we will have no involvement in setting the fee for such services, and any questions or concerns you may have about such fees should be directed to your dentist.

Company Functions Provided
DenteMax, LLC Leases dental network to Ameritas, Provider credentialing
Government Employees Health Association (GEHA) Connections Dental Network Leases dental network to Ameritas, Provider credentialing
EyeMed, LLC Leases vision network to Ameritas, Provider credentialing
P&R Dental Strategies, LLC Utilization review of dental claims
Zelis Leases dental network to Ameritas, Provider credentialing

You have the right to appeal our claims determination(s) or appeal an apparent lack of activity on a claim you submitted.

New Jersey Application to Appeal a Claims Determination

Your safety is important to us. Find information about your rights regarding domestic violence privacy and confidentiality.

NY Domestic and Sexual Violence Information

NY Confidential Communications Request Form