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Dental Plan Highlights
Dental Benefits Guardian
Benefits reset on a calendar year January 1st – December 31st
IN NETWORK
Guardian Dental
Deductible (Waived for preventive) Preventive
Basic
Major
Orthodontia
Maximum Benefit (per member)
Orthodontia Lifetime Maximum (per member) Waiting Period of Major Services
$50 100% 80%
80%
50% $2,000 $1000 Child Only
none
OUT– OF- NETWORK 90th UCR
Deductible Preventive Basic Major Orthodontia
$50 100% 60% 60% 50%
Deductible Waved for Preventive
Maximum Benefit (per member)
Orthodontia Lifetime Maximum Benefit (per member) Waiting Period for Major Services
Yes $1500 $1000 Child Only none
ADDITIONAL COVERAGE INFO
Perio and Endo Services
Major
Implants Covered
White Filing Covered Dependent Age / Student Age Open Enrollment
Yes All Teeth 26/26 Annual*
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