Page 15 - CC 2017 Benefits Booklet
P. 15

2017 EMPLOYEE BENEFITS GUIDE
         DENTAL







                     Guardian                 DentalGuard Preferred PPO                   DENTAL INSURANCE
                                                                                          Columbia College offers

                                                  Network          Non-Network            a comprehensive dental
                                                                                          plan through Guardian.
          Calendar Year Deductible                                                        You may use the dental
          (applies to Basic, Major & Ortho)                                               provider of your choice;
                      Individual                    $50                 $50               however, you will receive

                    Family Limit                          3 per family                    greater benefits by seeing
                                                                                          a participating network
                     Waived for                  Preventive          Preventive           provider. If you see a

          Calendar Year Maximum Benefit                                                   non-participating provider,
          (Applies to Basic & Major)                                                      the dental provider may
                                                                                          balance bill you for the
             Annual Maximum Benefit                $1,000              $1,000             difference between

                                                                                          Guardian’s accepted fee
          Dental Services Coinsurance
                                                                                          and the provider’s actual

                     Preventive                    100%                100%               charge.
             (exams, cleaning, x-rays,
                      sealants)
                        Basic                       80%                 80%
           (filling, root canals. simple ex-
                      tractions)                                                               Dental

                     Major Care                     50%                 50%               Contributions
             (crowns, dentures, bridges)                                                      (Monthly)

               Orthodontic Services                 50%                 50%              Employee       $9.30
                Maximum Rollover                                                            Only

                Rollover Threshold                            $500                      Employee +  $34.36

                 Rollover Amount                    $350                $250              Spouse
              Rollover Account Limit                         $1,000                     Employee +  $43.20

               Lifetime Orthodontia                                                      Child(ren)
                     Maximum                                 $1,500                        Family      $68.24


                                    To identify an in-network provider, call Guardian Customer Service at
                                    800-627-4200 or visit www.GuardianAnytime.com.

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