Page 11 - 2015 NISC Open Enrollment

2015 Open Enrollment

Dental

NISC offers two dental coverage options administered through Guardian.

Plan 1 Plan 2
Beneits PPO Network NISC offers dental
Only Network Non-Network coverage administered
Deductible through Guardian.
Individual $0 $50 $50
Family $0 $150 $150
Waived for Preventive N/A Yes Yes
Services
Preventive 100% 100% 100% Guardian Dental
Basic 100% 80% 80% To search for a network dentist:
Major 60% 50% 50% z www.guardiananytime.com
Other z Select Find a Provider
Annual Maximum $2,000 $2,000 $2,000 z Select Find a Dentist
Adult/Child Orthodontia 50% 50% 50% z Choose PPO from the drop
Orthodontia Maximum $2,000 $2,000 $2,000 down box
Waiting Period None None None z Enter zip code
Periodontics/Endodontics 100% 80% 80% Choose DentalGuard
Maximum Rollover Up to $600 Up to $600 Up to $400 z
Preferred from the drop down
box for “Select Your Dental
Rollover Network”
Guardian offers a rollover beneit which allows you to carry forward unused z Click Continue

beneit dollars from the prior two years up to $600 per year ($400 non-
network). Login to www.guardiananytime.com, click My Beneits, select the
person, and scroll down to view your personal rollover maximum amount.

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