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Dental Insurance
Dental
Good dental health is important to your overall well-being. At the same time, we all need different levels of dental
treatment. The Guardian PPO dental plan provides affordable coverage based on the type of services obtained –
Preventive, Basic or Major
– whether or not you obtain services from a network or non-network provider.
Under this plan, you may obtain covered services from any dentist. However, if an out-of-network is used,
reimbursement is based on Guardian’s usual and customary reasonable charge. Employees who use dentists or dental
specialists that are part of Guardian’s Provider Network
(Participating Dental Provider)
will see reduced out-of-pocket
expenses.
Dental Plan
In Network
Out of Network
Deductible
- Employee Only
$50
- Employee + Child(ren)
- Employee + Spouse
- Employee + Family
$150
Annual Maximum
$1,500
Coinsurance
- Preventive
100%
100%
- Basic
80%
80%
- Major
50%
50%
Orthodontia Lifetime Maximum
$1,000
Orthodontia Coinsurance
50%
50%
How to get in touch with Guardian
Employee Benefits Hotline
Benefits specialists available to answer additional questions
before
you enroll
Toll-Free Phone: 1-888-600-1600
(8:00 AM - 8:30 PM, Monday - Friday, Eastern Time)
Email:
ebh@glic.comor visit
www.GuardianAnytime.com and click on “Secure Channel” to send an
e-mail.
Plan Annual Maximum
Threshold
Maximum Rollover
Amount
In-Network Only Rollo-
ver Amount
Maximum Rollover
Account Limit
$1,500
$700
$350
$500
$1,250
Maximum claims reim-
bursement
Claims amount that deter-
mines rollover eligibility
Additional dollars added
to Plan Annual Maximum
for future years
Additional dollars added to
Plan Annual Maximum for
future years if only
in-network providers were
used during the benefit year
Plan Annual Maximum
plus Maximum Rollover
cannot exceed $2,750 in
total
Guardian will roll over a portion of your unused annual maximum into your personal Maximum Rollover Account (MRA). If you
reach your Plan Annual Maximum in future years, you can use money from your MRA.
To qualify for an MRA, you must have a paid claim (not just a visit) and must not have exceeded the paid claims threshold
during the benefit year. Your MRA may not exceed the MRA limit.
You can view your annual MRA statement detailing your account and those of
your dependents on
www.GuardianAnytime.com.