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Jason Powers: I’m Jason Powers, and I’m joined today by John Ritter with Ameritas. I pronounced it right-
John Ritter: Nice job-
Jason Powers: It’s not Ameritas.
John Ritter: Thank you.
Jason Powers: It’s Ameritas.
John Ritter: That’s correct.
Jason Powers: Sales representative for Ameritas, John, welcome to our Carrier product update. This is the first time you’ve been on our Q4 Kickoff Summit because it’s the first Q4 Kickoff Summit we’ve ever had. So, welcome to the studio. Welcome to the world of brokers-
John Ritter: Thank you-
Jason Powers: … out here. We’re anxious to hear what’s going on in Q4 with the exciting world of-
John Ritter: Dental insurance-
Jason Powers: … dental insurance. No, I think in all fairness, Ameritas is a… It’s actually not a new partner for us. Our partnership goes back to the inception of our company eight years ago, but we have not really done our due diligence to promote Ameritas as an option to our brokers, and that’s all changing with this Q4.
John Ritter: Good.
Jason Powers: We’re anxious to hear.
John Ritter: Well, I decided to take a little different approach today rather than do a deep product dive, which I’m happy to do at any time. But, I thought I would do a little kind of a retrospect to see where we’ve been, how we got to dental insurance today. Then, I’ll talk about dental trends, things we’re seeing today. Things we’re predicting in the future. Then, I’ll do a little bit of an overview about Ameritas.
Jason Powers: Sounds good. Look at the curtain. Wow.
John Ritter: I know that’s just a preview of things to come. Through the agenda today, I’m going to talk about, if I can read this here. I’m going to do an introduction to dental insurance, dental trends, as I said. I’m going to talk about, “Is dental insurance worth it?” I have people saying that they don’t think it’s worth it. They’d rather just pay their employees, reimburse their employees, rather than have insurance. Then, I’ll talk about Ameritas.
So, introduction, dental insurance was actually invented about 1954. It started off in the Pacific Northwest with a union plan for the longshoremen and the maritime workers. It was actually for the children, not for the adults. Because, these maritime workers would be out at sea for months, years at a time. So, they want to make sure their kids were taken care of. That’s the first known dental insurance plans that we’re aware of.
Then, you get to the 1970s where we start seeing the old, the DHMO roll out, the prepaid plans. The eighties, we started seeing commercial plans roll out. The nineties, introduced us to the dental PPO plans. That’s what we still have today is PPO plans. There are some DHMOS around, but not as prevalent as the PPO plans. So, that’s a little bit about where we [inaudible] Group plans, that’s what we all do, group plans. But, we are seeing a real rise in individual plans.
Jason Powers: Are you?
John Ritter: We see a ton of individual stuff. And every year, it goes up about 1%. For many reasons, people working from home, independent contractors, association health plans. If you’re a realtor and you have dental insurance, it’s through Ameritas, things like that, that’s helped us drive the individual plans up.
Jason Powers: I will say, most of the brokers that I’ve talked to over the last few years have migrated into that Medicare space. And as they get clients in that space that are approaching Medicare, I have often heard, “Well, they’re coming off of a group and now they’ve got to get an individual dental policy.” So, that makes sense.
John Ritter: Most of these, the big Medicare resellers that you go through we’re on their platforms, Ameritas, the individual plans, as a growing need. So, dental trends. Nationwide 80% of the population have dental benefits now, little less in… 72% of Missouri has it and Kansas a little less. So, we see that as an opportunity for doing more growth in the dental space. Let me turn the page here. I’m going to spend a little bit of time in this slide right here. As we were talking earlier, Jason, this is what we know right here. This is it.
Jason Powers: Every dental quote, it’s like, “Is it 100-80-50? Does it have a $1,000 cap? Is that a $50 deductible, and is it the lowest rate on the sheet?”
John Ritter: That’s it. I thought this would be higher, but 71% of all plans have 100-80-50 coinsurance. I’m going to talk about that in a minute. So, Type I represents about 60% of all claims, Type II about 25%, Type III, 15 and then Type IV, which is ortho, 15%. So, Type I, it’s your preventative or preventive, preventative or preventive? I think both are acceptable.
Jason Powers: I think it’s spelled both ways.
John Ritter: Yep.
Jason Powers: I’ve seen proposals where it’s spelled both ways in the same proposal.
John Ritter: So, preventive that’s your annual exams. You get two a year or three, cleanings, x-rays included in there. That’s 100%. Basic is 80%. That’s the 80. So what that means is that, you’ll pay 20% of the bill. We will pay 80% of the bill. That covers fillings, endodontics, periodontics, extractions. Type III, 50%, that’s the 50% one, that’s crowns, prosthodontics, sometimes implants. And, I’m going to talk about implants a little bit later on. And, Type IV is ortho, [00:06:00] and I’m going to talk also about ortho a little bit further on also. So 71%, most of the plans are 100-80-50, only 9% are greater, and those are generally like 100-90-60 plans and lesser plans, only 20% or lesser than. So, you can see when we joke about 100-80-50, that’s it.
Jason Powers: I got to say, I think and I don’t know if this is where you’re heading, but I think it’s because no one’s showing anything different than 100-80-50.
John Ritter: Also, everyone’s spreadsheets are set up that way. But, they’re all preset up 100-80-50. If you throw in something different, different kind of things like dental rollover, Preventative Plus, anything different, now they have to change it. “Where am I going to put this in my spreadsheet, where does that fit in?” That’s part of the problem. And everybody has 100-80-50, if you want a matching plan. That’s what we give them.
Jason Powers: What I often wonder is, if employers who are making the decisions for the dental plan even know that they can change, that they can have different co-insurances for different levels-
John Ritter: Here’s the thing. We know that… A dinner plate is a metaphor. Medical is a steak. Dental’s like the mashed potatoes maybe or the corn. [00:07:30] Dental makes up about 5 to 7% of the overall employer benefit spend. So, we’re not the main topic. That’s kind of like after Medical’s done, “That’s put to bed.” Let’s talk about the dental, so what do we got?
Jason Powers: It’s always on the way out the door. In our office, it’s generally Andrea gets a notification that we’ve got a medical case that’s sold and get ready to be submitted with XYZ medical carrier. Then, the week before we go live, she gets another email that says, “Oh, we need a dental quote.”
John Ritter: Yeah, that’s my point. It’s not the top of topic here. I’m going to spend a little bit of time on this, annual maximums. So, 100-80-50, 50 deductible, $1,000 annual max. So, how to read this chart here is, this is a number of people who hit that annual maximum. So, the $500, it says that 18%… So, 18% of our members, this is from our internal block, which is a large block of business. 18% of our members hit $500. It’s still Pareto’s rule, the 80-20 rule. So, about 20% hit $500. So, $1,000, you’re thinking like, “All right, 7%.” So, only 7% hit $1,000 dollars. So when we see groups out there, brokers saying, “Hey, we want a max of $2,000 or $2,500.” 1% hit $2,000, which [inaudible 00:08:59], in raising the question. You see those unlimited max plans? No one’s hitting those.
It looks great. But from our numbers, we’re seeing… In fact, we’re seeing, what we’ve seen Jason over the last three years is a decrease in annual maximums. We had about 10% of our plans had a $2,500 max in 2020, that dropped down to 7% in 21. And now 2022, 5% of our groups have a $2,500 maximum or greater.
Jason Powers: [00:09:30] Wow.
John Ritter: So, we’re seeing a decrease because one, we’re doing a better job as reps informing and educating, if you will, the brokers on, “These are the numbers. Why do you want to have over insurance? Why do you want to pay for $2,000 annual max when no one’s using it?” However, you know who is using it? The owner, the owner’s spouse, or kids needs something, that’s who wants the $2,000 max for implants. That’s why they take it for themselves. Also, dental rollover, Preventive Plus, we think is a better value to have maybe $1,000 annual max, buy dental rollovers? Which, by the way, I heard the previous guy talking. Ameritas actually invented, we’re the Al Gore of dental rollover. We invented the rollover.
Jason Powers: So, every time I explain dental rollover, I think of the old singular wireless rollover minutes.
John Ritter: That’s a good one. Singular, wow. That was the Al Gore [inaudible]-
Jason Powers: That’s before AT&T took over.
John Ritter: Yep, before Southwestern Bell also. Preventative Plus that’s just where the… Your Type I doesn’t count towards your annual max. It’s just taken out.
Jason Powers: That probably helps keep people from hitting that $500,000.
John Ritter: It does because dental rollover, the way it works is that you have to file a couple of claims, and you have to stay under $500. Then the cares will roll over a set amount to next year’s annual maximum. It’s a really nice feature. It allows you to have a higher maximum while paying for the lower one. It’s a nice deal.
Jason Powers: But, you got to at least use the benefit. You can’t just stock pile-
John Ritter: Dental, we want you to use it. We want you to go get your cleanings [inaudible].
Jason Powers: Makes sense.
John Ritter: Looking beyond 100-80-50, so here we are making fun of 100-80-50 plans. What else can you look at? So, we recommend looking at different options. For example, perio and endo. Do you know what endo means?
Jason Powers: So, perio is gums. Endo is the root canals.
John Ritter: Yeah, perio means around. Endo means in. Endodontics, root canals, periodontics, gums. People argue about, “Should we have it in Type II or Type III?” That’s the big thing. “Should we have it [inaudible]-
Jason Powers: Is it basic or major?
John Ritter: Yeah. Doesn’t really matter. You have an annual maximum set. Either way, you’re going to hit it. If you have a root canal, a crown, you’re going to hit that $1,000 max. You’ll just get there faster in the major than you would on the basic. So, different things like that and also amalgam versus composite. Do you know what amalgam is?
Jason Powers: That’s the silver, right, silver fillings versus the white resin?
John Ritter: That is correct. So, my background, believe it or not, I was in the air force way back when, and I was actually in the dental clinic. I was a dental assistant, dental hygienist, and people ask, “Why didn’t you become dental hygienist in the real world?” Ever seen a male hygienist? So, I know how all the stuff is made. So, amalgam is actually, it’s a mixture of copper, tin, and silver. And, it’s a pallet, and you mix with liquid mercury, little machine that breaks it up and it becomes like a paste, like a putty. Then, you pack it in the tooth, and you carve it off. In fact, you see all those catalytic converters that are stolen all the time for precious metal, you know where the metal goes to… amalgam. Most dentists don’t use amalgam anymore. They use composite, which is the tooth colored material. However, most dental quotes don’t cover composite resin fillings. You need to ask for that. We [inaudible] included it, shameless plug for Ameritas.
Jason Powers: No, that’s good.
John Ritter: We include it because the old silver fillings like I have. You probably have some also. Now, they’re all going to a two color composite their called.
Jason Powers: That’s something that doesn’t make the spreadsheet.
John Ritter: No, no, it does not actually, you have to look for in the fine print. Implant coverage, we’re seeing more and more implants. Implants is… Now, this is where the technology of dentistry has really changed. Implants are made with titanium, so a titanium screw. Normally, you would have an implant, if you lost a tooth. It’s a permanent replacement where you might have a bridge before or a partial denture. Now, the implant is a permanent replacement. It is a titanium screw. So normally, you have the tooth pulled, your root tips are… left some holes there.
Jason Powers: I’m exploring my mouth over here while-
John Ritter: As I speak.
Jason Powers: Yeah.
John Ritter: They take freeze, dried cadaver bone. You heard, it’s called a bone graft-
Jason Powers: Graft, yeah.
John Ritter: Bone graft, it’s cadaver bone they put in there, and they pack it in. They sew it back up again and three months later it becomes part of your bone. Then they go with a drill bit and they screw it in and this little torque wrench, little ratchet, they ratchet in the titanium implant. And, the reason why it’s titanium is titanium actually bonds to the bone. That’s why it’s titanium. Then, that’s packed up for three months and then they put on the crown. Most dental offices have 3D crown printers now or lot of the newer places do, I should say. So, they can build a crown in their office. They’ll image your mouth 3D and build a crown, put it on.
Jason Powers: Wow.
John Ritter: That’s your implant. But, that technology does not come cheap. Typical implant $4,500, $6,000 an implant.
Jason Powers: Wow.
John Ritter: So, these commercials for a whole mouth of implants, it’s like a house payment. It’s a big amount. So, that’s why it’s not covered often because $1,000 isn’t going to do much for an implant. So, when I mention about the owner who wants the $2,500 max to cover the implant, now you see why. So dental insurance, is it worth the cost? Let’s take a look at that. It’s not your typical insurance. You go in twice a year. Name me another benefit, Jason, you can go in twice a year, see a doctor educated level professional there, spend an hour there, for examining you, him or her examine you. You get your teeth cleaned, x-rays. You walk out owing nothing.
Jason Powers: That’s why you buy dental insurance.
John Ritter: That’s it. That visit is worth about $150 or so, two visits, $300. So, you do the math. “What am I spending on dental insurance? Am I getting the value out of it?” Oral health versus overall health. I went to a competitor’s forum in St. Louis a few years, and they were talking about oral health to your overall body health. If you have bad teeth and bad gums, chances are you have other problems. Also, bacteria spreads through your blood system and stuff. Kids should go also. Self-esteem, my brother’s missing a tooth for a few years, he wouldn’t smile. He was talking like this, self-esteem. He once had missing teeth. Employee retention, you might have noticed, you’ve seen in the news. There’s a employee shortage out there right now. You want to retain employees?
Jason Powers: Buy them dental insurance.
John Ritter: Buy them dental insurance. So orthodontics, when my daughter had braces, they were about $3,000. Now they’re upwards of $6,000. So, when we see ortho benefits low… I’ll talk about that later.
Jason Powers: I’ve had a kid in braces, this particular kid has been in braces three times.
John Ritter: Also, the other big change we’ve seen is, with orthodontics, which Invisalign and Smile Direct Club, two newcomers. We’re seeing more adults buying ortho. If you’re an adult in the Zoom world we live in, this world we live in where we’re online the whole time, “Do you want to have crooked teeth, or do you want to spend some money and get your teeth straightened with that invisible tray that you wear that aren’t steel braces on there?” So, we’re seeing a real uptick in-
Jason Powers: Adult ortho-
John Ritter: Adult ortho and it’s not that much money to add it, just check it out. So, I think that covers… And now, we’re going into the Ameritas part here. So, Ameritas, that’s who I work for. We are a Midwest company, Midwest [00:18:00] values, Midwest attitude. We’re based on Lincoln, Nebraska. We have roughly about 3,000 employees. We’re about a $3 billion company. We offer… We kind of joke about this. We say, “We’re above the neck company.” Vision, teeth, dental, hearing, offer hearing benefit, and LASIKs, we offer a LASIKs benefit also. Four basic products under our umbrella. For vision, we partner with EyeMed and VSP, basically the two preeminent vision carriers. We are in fact, VSP’s largest reseller. I think the reason why that is, is because we partner with The Standard and Reliance Standard. So, if you purchase dental or vision through Reliance Standard or The Standard, it’s Ameritas.
Jason Powers: Just so that people are clear, that’s using the EyeMed network-
John Ritter: Correct-
Jason Powers: … the VSP network, but you’re administering the claims-
John Ritter: Correct-
Jason Powers: … and the billing and the eligibility.
John Ritter: Yep. EyeMed is a large… They’re different entities. EyeMed, very large network. We always kind of say their more retail box driven, and VSP is more provider driven-
Jason Powers: Private practice kind of stuff-
John Ritter: Private practice, your right. And oddly enough, though, VSP does have Walmart in their network, which is different. I think the reason why I was told was because that VSP does the vision insurance for Walmart employees, which that makes sense-
Jason Powers: Yeah, totally makes sense.
John Ritter: We started doing dental in 59, vision 84. Remember, I mentioned that dental insurance started about 1954. So, we were on the cutting cusp. It’s hard to say who was the first real dental carrier in America. We think we are, but we’ve heard different Delta plans state that they are. So, why don’t we say we are-
Jason Powers: Sure-
John Ritter: Just for today.
Jason Powers: Sure.
John Ritter: We are.
Jason Powers: I don’t know any difference so…
John Ritter: Who’s going to verify that. So, let’s talk about market trends. If you recall it, I was…
Jason Powers: You want to cover network, or you want to go with market trends?
John Ritter: Let’s cover both. Let’s cover market trends. Look, actually, let’s go back to the vision insurance. [inaudible], one more down.
Jason Powers: One more, there we are.
John Ritter: So, VSP and EyeMed, one of the advantages that we have is that we can offer both. So, if we have 50 life group, 100 life group, 100 life… a company, and they’re located everywhere. Some rural areas, EyeMed is a better fit. Some of the urban areas, VSP might better fit. We can offer both. The employees can choose one at the time of enrollment, and they are, I’d say stuck, but they have that carrier for the entire year and could change the next year. But, we offer that choice. You can offer both carriers, which is unique to Ameritas.
Jason Powers: Yeah, I’ve seen that. We quote it both ways. We quote it, one or the other, and then we quote both.
John Ritter: We can offer EyeMed. We can offer VSP. We can offer both. But, it has to be 20 lives and above to offer both. Does 10 life group make sense or five life group, not really.
Jason Powers: No.
John Ritter: Dental trends, actually market trends. There are both dental and vision. Here’s what we’re looking at. What we’re seeing is at Ameritas the last couple years and yeah, this pandemic has made things a little bit odd, [00:21:30] but these are what we’re seeing. As I mentioned, Invisalign, SmileDirect or different option, we’re seeing more towards adult ortho.
As I mentioned, the cost has gone up dramatically for braces. So, if you’re offering that 100-80-50, $1,000 annual, $1,000 ortho max, $1,000 is not going to go very far towards $6,000 coverage. So, we recommend $2,000, $2,500, $3,000, give the employees a benefit that they can say, “Wow, this is going to make a difference in our kids orthodontia expenditure.”
Annual maximums, we talked about annual maximums. We’re seeing a lowering of annual maximums. We don’t see much $1,500, $2,000 annual maxes anymore. Oddly enough, we just sold a $3,000 annual max, but it was a giant group, and that’s what they had before. So dental, vision benefits are a little different. So, medical insurance, you need stay in-network. If you don’t, you’re penalized. Dental, not the case, dental you can go in or out with UNC, instead of 90 or 95th percentile, which is a different seminar by the way, the UNC and MAC plans.
Jason Powers: It depends on what year manual they’re using. You want customary from this year or you just want customary from 10 years-
John Ritter: And, how often? We update ours quarterly, by the way. Vision insurance, you need to stay also in network. If you go out-of-network in vision insurance, you take a big haircut for your benefits. So, things we’re seeing in the vision benefits world is most vision and dental has become voluntary. We see very few employer sponsored plans, if they do, it’s 50%. I think the old days of 100% sponsored plans are gone, just don’t see those anymore. Since they’re voluntary, the employees will find a value in paying a little bit more money for $150 or $180 frame allowance. What is a typical vision plan? 12-12-24, $10, $25 deductibles with $130 frame allowance.
Jason Powers: That’s what every spreadsheet I see says.
John Ritter: Everyone has it. So, if you’re selling vision, be different. If you’re out to prospecting, ask your prospect, “Hey, what’s your vision plan like? $130, 30, we’re finding that not adequate enough. Have you looked at the cost difference between $150 or $180?” It isn’t that much money.
Jason Powers: No.
John Ritter: Also, 12-12-12s. What that means is, every 12 months you get an exam. Every 12 months you get new lenses or contacts. Every 12 months, you also get new frames. Do you want to wait 24 months for new frames? Again, the cost isn’t that different. So, VSP recommends going with a 12-12-12 and $150 or $180 frame allowance, if it’s voluntary. If it’s employee-sponsored and there are employer-sponsored vision plans given the low cost of the vision plans. In that case, they said stick with the 12-12-24, $130 frame allowance since employers paying for it. Again, the increase in benefits far outweigh the premium differential in it.
Jason Powers: Premiums have come down. So, there was a time where it didn’t mathematically make a lot of sense to buy vision insurance. I think over what I’ve seen in the benefit side, just here at Legacy over the last eight years, the price point on vision, you’re talking between $6 and $8 for employee coverage for the year, per month, I mean. So, take that out for a year. That’s $70 to $100 in premium for the year, and they’re getting $150 benefit on a pair of glasses, and they’re paying a $10 copay for the exam, $25 for the materials. Mathematically, it works out to where the employee wins.
John Ritter: When I do open enroll meetings, I always, “Who wear glasses here? Who wears contacts?” Getting a judge of the crowd. I’ll tell them, “If you do, you should take this plan. It pays for itself.” I just wonder how they make money on these plans. Because, you’re right, let’s say it’s $750 a month. It’s not that much money. You get the value. Just the exam and stuff, you get that money back again.
Jason Powers: One eye exam with a contact fitting is going to cost you more than $90 bucks.
John Ritter: Now, think about vision also. Vision is different. Where medical and dental plans run calendar year, January 1st, December 31st. Vision plans [inaudible] 12-12-12. That means if you have an exam on June 1st, you don’t get another exam again until-
Jason Powers: June 1st-
John Ritter: … June 1st. If you have frames, you’re waiting 24 months. It’s not like you go next year after 11 or 13 months get new frames.
Jason Powers: No, it’s from the time-
John Ritter: You’re waiting 24 months, and who wants to wait two years for new frames?
Jason Powers: Nobody.
John Ritter: So, we didn’t talk much about dental networks as far as we, Ameritas has our own dental network, kind of flip flop back around from vision to dental, back to dental. But, didn’t want to forget about that. On networks, we have, the larger networks, anywhere between third and fifth, depending on the cities. So, a decent network, it’s our own network, good discounts. And, that’s why you join a dental plan, for the discount. So, your $1,000 now represents more like $1,300, $1,400 true dental cost with the discounts you get. So, we kind of gloss over that slide.
Jason Powers: Any parting thoughts for agents as they get into Q4? You’ve seen a few Q4s.
John Ritter: Yeah, more than I care to admit. Sometimes let’s say you’re out there prospecting. Sometimes, the medical just… You can’t touch it. Getting your foot in the door, look at dental and vision benefits say, “Hey, here’s some trends I’m seeing. Here’s something different. Have you thought about that? Has your agent talked to you about that?” He or she hasn’t by the way, because they’re focused on the medical, the big spend. Get your foot in the door.
Your current clients, spend some time, spend a little bit time with them on the dental and vision benefits. Don’t gloss over it. Take a look at networks, benefits, enhancements, the costs aren’t that different. Even a 10% difference is $1.50, $2. It’s not much of a difference with our plans and the vision rates, as you said, are so low. Vision insurance, if they don’t have vision insurance and a lot of employees don’t have it, I’m always amazed how many virgin plans I see coming across. Suggest it, make employee sponsored voluntary. We call it a low-cost, high-impact benefit. Low-cost and the benefit you get from that is fantastic. So, those are few parting things that I see in fourth quarter.
Jason Powers: Well, you heard it from John, and I’ll tell you right here, Stephanie Douglas in our office is anxious and willing to quote your Ameritas business. So, if you’ve got a medical case you’re working on right now with her, be sure to ask for her to add that Ameritas dental and vision quote. If you’ve got a renewal that you’re working on with Theresa in our office, make sure you ask her for a dental and vision renewal quote.
John Ritter: And surprise us, ask for something, ask for 100-90-60 points, surprise us.
Jason Powers: Yeah, be different-
John Ritter: Different.
Jason Powers: I love it. John, well, thank you-
John Ritter: Thank you, Jason-
Jason Powers: … so much for being a part of this.
John Ritter: Thank you.
Jason Powers: We look forward to a continued build of our relationship together and with that brings a new book of business.
John Ritter: Well, I hope this was a little insightful. I wanted to spend a little time on different topics, so I hope this helped.
Jason Powers: Yeah, definitely. Well that’s it from Ameritas. We’ll see you next time. Thank you very much.
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