Page 19 - Guide
P. 19
Dental Coverage
Dental
Our dental plan makes dental care more affordable for employees and This summary of beneits is intended to be a
their families. Research suggests the health of your mouth mirrors the brief outline of coverage. The entire provisions
of beneits and exclusions are contained in
overall health of your body. Which is why we offer dental coverage the Summary Plan Description (SPD). In the
event of a conlict between the SPD and this
through our insurance partner Guardian. With this coverage you description, the terms of the SPD will prevail.
will have broad access to in-network providers. With an expansive Weekly Contribution Rates
selection of in-network providers you have a better chance of avoiding Base Premier
additional out-of-pocket exposure or “balance billing”. Balance Employee $5.35 $6.12
billing is the practice of non-network providers billing the patient for Employee + spouse $11.24 $12.85
$16.58
Employee + child(ren) $9.63
amounts exceeding the reimbursement amount under your Guardian Family $17.13 $22.78
dental plan. When this happens, you are responsible for the additional
amounts charged. Make sure your dentist is in Guardian’s Network at
www.guardianlife.com. Stay in-network and ensure your savings! Special benefit: if a
member submits at least
Dental Base Plan In-network Out-of-network 1 claim and stays under
Annual Deductible $500 a part of the unused
Individual $50 maximum will be rolled
Family limit 3 per family 3 per family over for use in future
Waived for Preventive Preventive
Charges Covered for You (Coinsurance) years
Preventative care (e.g., cleanings) 100% 100%
Basic care (e.g., illings) 80% 80%
Major care (e.g., crowns, dentures) 50% 50%
Orthodontia Not covered Not covered
Annual maximum beneits $1,000
Dependent age limits To age 26 To age 26
We are excited to announce we are offering a second dental plan option.
The new plan features higher plan maximums and orthodontia coverage.
The following chart is a summary of the new dental plan option.
Dental Premier Plan In-network Out-of-network
Annual Deductible
Individual $50
Family limit 3 per family 3 per family
Waived for Preventive Preventive
Charges Covered for You (Coinsurance)
Preventative care (e.g., cleanings) 100% 100%
Basic care (e.g., illings) 80% 80%
Major care (e.g., crowns, dentures) 50% 50%
Orthodontia (children to age 26) 50% up to $2,000 lifetime maximum
Annual maximum beneits $2,000
Dependent age limits To age 26 To age 26
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Dental
Our dental plan makes dental care more affordable for employees and This summary of beneits is intended to be a
their families. Research suggests the health of your mouth mirrors the brief outline of coverage. The entire provisions
of beneits and exclusions are contained in
overall health of your body. Which is why we offer dental coverage the Summary Plan Description (SPD). In the
event of a conlict between the SPD and this
through our insurance partner Guardian. With this coverage you description, the terms of the SPD will prevail.
will have broad access to in-network providers. With an expansive Weekly Contribution Rates
selection of in-network providers you have a better chance of avoiding Base Premier
additional out-of-pocket exposure or “balance billing”. Balance Employee $5.35 $6.12
billing is the practice of non-network providers billing the patient for Employee + spouse $11.24 $12.85
$16.58
Employee + child(ren) $9.63
amounts exceeding the reimbursement amount under your Guardian Family $17.13 $22.78
dental plan. When this happens, you are responsible for the additional
amounts charged. Make sure your dentist is in Guardian’s Network at
www.guardianlife.com. Stay in-network and ensure your savings! Special benefit: if a
member submits at least
Dental Base Plan In-network Out-of-network 1 claim and stays under
Annual Deductible $500 a part of the unused
Individual $50 maximum will be rolled
Family limit 3 per family 3 per family over for use in future
Waived for Preventive Preventive
Charges Covered for You (Coinsurance) years
Preventative care (e.g., cleanings) 100% 100%
Basic care (e.g., illings) 80% 80%
Major care (e.g., crowns, dentures) 50% 50%
Orthodontia Not covered Not covered
Annual maximum beneits $1,000
Dependent age limits To age 26 To age 26
We are excited to announce we are offering a second dental plan option.
The new plan features higher plan maximums and orthodontia coverage.
The following chart is a summary of the new dental plan option.
Dental Premier Plan In-network Out-of-network
Annual Deductible
Individual $50
Family limit 3 per family 3 per family
Waived for Preventive Preventive
Charges Covered for You (Coinsurance)
Preventative care (e.g., cleanings) 100% 100%
Basic care (e.g., illings) 80% 80%
Major care (e.g., crowns, dentures) 50% 50%
Orthodontia (children to age 26) 50% up to $2,000 lifetime maximum
Annual maximum beneits $2,000
Dependent age limits To age 26 To age 26
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