Page 10 - Ifly Benefit Guide 2018 FINAL

Benefits

Dental Insurance
Guardian | PPO Dental Plans
With the Guardian Preferred Provider Organization (PPO) dental plan, you may visit a PPO dentist and benefit from the negotiated
rate or visit a non‐network dentist. When you utilize a PPO dentist, your out-of-pocket expenses will be less. You may also obtain
services using a non-network dentist; however, you will be responsible for the difference between the covered amount and the
actual charges and you may be responsible for filing claims.

Guardian Guardian
Plan Name Value Plan NAP Plan
Network Name DentalGuard Non-Network DentalGuard Non-Network
Preferred Texas Fee Schedule Preferred NAP Texas 90th Percentile UCR
Dental Benefits
Calendar Year Maximum $1,000 $1,000 $1,000
Deductible (Annual)
- Individual $50 $50 $50
- Family $150 $150 $150

Preventive No Charge No Charge No Charge No Charge
Basic Services Deductible, 0% Deductible, 0% Deductible, 20% Deductible, 20%
Major Services Deductible, 40% Deductible, 40% Deductible, 50% Deductible, 50%
Orthodontia
- Covered Members Children Only Children Only Children Only
- Coinsurance 50% 50% 50%
- Lifetime Benefit Maximum $1,000 $1,000 $1,000

Important-Find a Dental Provider Before you Select a Plan
Go to www.guardiananytime.com or call (888) 600-1600. Value Plan participants should refer to the
“DentalGuard Preferred Texas” network and NAP plan participants should refer to the “DentalGuard
Preferred NAP Texas” network when prompted. If your dentist is in the DentalGuard Preferred Network,
you will receive a higher level of benefits on the Value plan. If your dentist is out of network, you will
receive a higher out of network reimbursement level on the NAP plan.

Tips For Using Your Dental Benefits

Use contracted network providers when possible.
Under the PPO plan, contracted network providers have rate agreements with insurance companies for services rendered. If
you use a non-network provider, your out-of-pocket expenses will be higher and you may be subject to balance billing.

Ask for a predetermination of benefits.

We strongly recommend you ask your dentist for a predetermination if total charges are expected to exceed $300.
Predetermination enables you and your dentist to know in advance what the payment will be for any service that may be in
question.


Have dental checkups regularly.
Routine dental visits not only preserve your smile, but they can provide an opportunity for the early detection of serious
diseases such as diabetes.
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