Page 15 - CC 2017 Benefits Booklet

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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