NPCA 2018 Guide

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DENTAL BENEFITS
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: r visit nd click on “Secure Channel” to send an e-mail.
Plan Annual Maximum Threshold
Maximum Rollover
Amount
In-Network Only
Rollover Amount
Maximum Rollover
Account Limit
$1,500 $700 $350 $500 $1,250
Maximum claims
reimbursement
Claims amount that
determines 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