Page 14 - McLarty 2017-2018 Benefits Booklet

DENTAL FROM GUARDIAN

Guardian DentalGuard Preferred PPO DENTAL INSURANCE
Highlights:

Network Non-Network • McLarty pays a large portion
of employee premium
Calendar Year Deductible (applies to Basic & Major)
• Two free preventive
Individual $50 $50 cleanings

Family Limit 3 per family • One free X-ray
• $1000 max rollover
Waived for Preventive Preventive • In order to qualify for max

Calendar Year Maximum Benefit rollover you must do the
(Applies to Basic & Major) following:
1. Access your dental
Annual Maximum Benefit $1,000 $1,000 at least once in the

calendar year
Dental Services
Coinsurance 2. Use $500 or less of
your $1,000 maximum
Preventive 100% 100% benefit
(exams, cleaning, x-rays,

sealants)
Basic 80% 80% Your Monthly Dental
(filling, root canals. simple Premium
extractions)

Major Care 50% 50%
(crowns, dentures, bridges) 10/1/2017- 1/1/18-
12/31/2017 12/31/18
Orthodontic Services 50% 50%
Employee $17.62 $19.62
Maximum Rollover Only

Rollover Threshold $500 Employee + $46.61 $48.61

Rollover Amount $350 $250 Spouse
Rollover Account Limit $1,000 Employee + $56.59 $58.59
Child(ren)
Lifetime Orthodontia
Maximum $1,000 Family $84.79 $86.79

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