Page 17 - Impact Floors 2022 Benefit Guide

Voluntary Dental plan

It’s important to have regular dental exams and cleanings so problems are detected before they become painful — and
expensive. Keeping your teeth and gums clean and healthy will help prevent most tooth decay and is an important part of
maintaining your overall health. This year we will be offering dental insurance through Guardian.

Guardian DPPO Plan
Plan Provisions In-Network Out-of-Network
Annual Deductible $50/$150 $50/$150
(Individual/Family)
$2,500 per individual $2,500 per individual
Calendar Year Maximum
(Basic and Major Services combined) (Basic and Major Services combined)
Diagnostic and Preventive Services Covered at 100% 100%
(e.g., X-rays, cleanings, exams)
Basic and Restorative Services 80% 80%
(e.g., fillings)
Major Services
(e.g., dentures, crowns, bridges) 50% 50%
*After footnote
Your payroll contributions for medical benefits are shown here.

Guardian DPPO Plan
Coverage Level Semi-Monthly Bi-Weekly Weekly
Employee Only $16.75 $15.46 $7.73

Employee + Spouse $33.99 $31.38 $15.69
Employee + Child(ren) $39.40 $36.37 $18.18

Family $60.14 $55.51 $27.76

Using in-network dental providers
While you have the option of choosing any provider, you will
save money when you use in-network dentists. When using an
out-of-network dental provider, you will pay more because
the provider has not agreed to charge you a negotiated rate.

Additionally, Guardian Dental plans offer annual roll over for
unused benefit dollars. You have the ability to roll over up to
$450 per year. Roll-over amount varies based on unused
benefit dollars

Find a Provider:
1. Go to www.guardianlife.com
2. Select “Connect with us” and then “Find a Provider”
3. Select plan type and search by location

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