Page 13 - Enrollment Guide
P. 13
American Food & Vending
Dental
Dental Coverage
Our dental plan makes dental care more affordable for employees and Special Benefit: if a
their families. Research suggests the health of your mouth mirrors member submits at least
the overall health of your body. That’s why we offer dental coverage one claim and stays under
through our insurance partner Guardian. With this coverage you’ll have $500 a part of the unused
maximum will be rolled
broad access to in-network providers. With an expansive selection of over for use in future
in-network providers you have a better chance of avoiding additional years
out-of-pocket exposure or “balance billing”. Balance billing is the
practice of non-network providers billing the patient for amounts
exceeding the reimbursement amount under your Guardian 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!
Dental 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 Not covered Not covered
Annual Maximum Beneits $1,000
Dependent Age Limits To age 26 To age 26
This summary of beneits is intended to be a brief outline of coverage. The entire provisions
of beneits and exclusions are contained in the Summary Plan Description (SPD). In the event
of a conlict between the SPD and this description, the terms of the SPD will prevail.
Weekly Contribution Rates
Employee $5.33
Employee + Spouse $11.20
Employee + Child(ren) $9.60
Family $17.07
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Dental
Dental Coverage
Our dental plan makes dental care more affordable for employees and Special Benefit: if a
their families. Research suggests the health of your mouth mirrors member submits at least
the overall health of your body. That’s why we offer dental coverage one claim and stays under
through our insurance partner Guardian. With this coverage you’ll have $500 a part of the unused
maximum will be rolled
broad access to in-network providers. With an expansive selection of over for use in future
in-network providers you have a better chance of avoiding additional years
out-of-pocket exposure or “balance billing”. Balance billing is the
practice of non-network providers billing the patient for amounts
exceeding the reimbursement amount under your Guardian 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!
Dental 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 Not covered Not covered
Annual Maximum Beneits $1,000
Dependent Age Limits To age 26 To age 26
This summary of beneits is intended to be a brief outline of coverage. The entire provisions
of beneits and exclusions are contained in the Summary Plan Description (SPD). In the event
of a conlict between the SPD and this description, the terms of the SPD will prevail.
Weekly Contribution Rates
Employee $5.33
Employee + Spouse $11.20
Employee + Child(ren) $9.60
Family $17.07
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