Dental Insurance—Guardian Dental PPO
To find a participating dentist, visit www.guardiananytime.com . The list of available dentists is not guaranteed and it is advisable to ask your dentist if they are currently participating or accepting new patients. Although the Guardian Dental plan allows you the freedom to visit any licensed dentist, you will save more on your out - of - pocket costs when you visit a Guardian PPO dentist. The Guardian Platinum network also provides cost saving features and is the next best option. Ask your dentist if they are a Guardian Platinum or Gold/Silver provider to choose the plan that ’ s right for you. The dentist you choose could affect your cost.
Plan Design - Administered by Guardian Dental
Facts and tips You are always free to select the dentist of your choice. However, if you choose a dentist who does not participate in the Guardian program, your out - of - pocket expenses may be greater, since you will be responsible to pay for any difference between the dentist's fee and your plan's payment for the approved service. If you receive services from a participating dentist, you are only responsible for the difference between the in - network fee for the service provided and your plan's payment for the approved service. Please note: any plan deductibles must be met before benefits are paid.
Features
Platinum
Gold/Silver
Non Contracted
Deductible (Calendar Year) (Individual / Family)
$50 / $150
$50 / $150
$50 / $150
Type I - Preventive Care: (Exams, Cleanings, X - rays) Type II - Basic Procedures: (Fillings, Extractions) Type III —Major Procedures: (Caps, Crowns, Bridges, Dentures)
100% (No Ded.)
100% (No Ded.)
100% (No Ded.)
80%
80%
90%
60%
50%
50%
Endodontics:
90%
80%
80%
Periodontics:
90%
80%
80%
Type IV —Orthodontia: (dependent children under age 19)
50% to $2,000 Lifetime Maximum
50% to $2,000 Lifetime Maximum
50% to $2,000 Lifetime Maximum
Maximum Benefits/Year
$2,000
$2,000
$2,000
◼ Certain services may have frequency and/or age limitations. The limits are described in the Guardian Dental Certificate of Coverage or you can contact Guardian Customer service for specific details.
Monthly Dental Employee Cost Coverage Type
The amounts shown are the employee share of premium after the district $ 41.72 monthly dental benefit allotment.
Employee
$0
$ 41.72 $ 60.02 $ 101.79
Employee/Spouse
Employee/Children
Family
10
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