Product options may not be available in all states. Product options and rates may vary by state.



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Flex Term Health Insurance
This FlexTerm Health Insurance Plan does not qualify as the minimum essential coverage required by the Affordable Care Act (ACA). Unless you purchase a plan that provides minimum essential coverage in accordance with the ACA, you may be subject to a federal tax penalty. Underwritten by Everest Reinsurance Company, rated A+ Superior by the A.M. Best Company (9/9/15). A.M. Best is an independent global rating organization that examines insurance companies and publishes its opinion on their financial strength. Everest Reinsurance Company 100 Everest Way, Warren, NJ 07059 Flex Term Health Insurance. Benefits not available in all states at this time. Members can be enrolled only once. Duplicate or multiple memberships are not allowed. Coverage is not provided for members age 65 or over, coverage will terminate at the end of the month insured turns age 65. If coverage is canceled, persons may not re-enroll in coverage with Everest Reinsurance Company until six months after their termination date. There is a 3% merchant account fee added to the premium for credit card and EFT processing. This coverage contains a Pre-Existing Condition Limitation. Pre-Existing Condition means a condition for which a Covered Person received medical treatment, diagnosis, care or advice, including diagnostic tests or medications, during the months prior to the Covered Person’s effective date of coverage.

Core Dental Insurance
The policy provides dental and/or vision benefits only. Review your policy certificate carefully.

The policy provides limited benefits. Review your policy carefully.

By submitting your application using this form, you hereby apply for coverage. This policy has limitations, exclusions, terms and conditions under which the policy may be continued in force or discontinued.

Underwritten by Ameritas Life Insurance Corp. | 5900 O Street Lincoln, NE 68510

This highlight 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. Premium rates may change upon renewal. This policy is renewable at the option of the insured.

This information is provided by Ameritas Life Insurance Corp. (Ameritas Life). Individual dental, vision and hearing care products (Indiv. 9000 Rev. 02-19), and vision policy form (Indiv. 9000 Rev. 02-19 V, dates may vary by state) are issued by Ameritas Life. This piece is not for use in New Mexico. The Ameritas Dental Network is not available in MT or RI. In Texas, our dental network and plans are referred to as the Ameritas Dental Network. Some states require that producers be appointed with Ameritas Life before soliciting its products.

Please note: Your insurance is effective on the date you selected during enrollment, but you may need to call for verification of benefits if you have an appointment during the first few days of coverage. Our application process may take up to five business days after your application is submitted. If you visit your dental or vision provider during that time, you may need to contact Ameritas customer service at (800) 300-9566 for verification of benefits.

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