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BENEFITS

Dental Insurance

Guardian | DHMO
With the Dental Health Maintenance Organization (DHMO) plan through Guardian, you are required to select a general dentist
who is a member of the Managed Dental Care network to provide your dental care. You will contact your general dentist for all of
your dental needs, such as routine check‐ups and emergency situations. If specialty care is needed, your general dentist will
provide the necessary referral. For covered procedures, you'll pay the pre‐set copay or coinsurance fee described in your DHMO
plan booklet. Please keep a copy of your booklet to refer to when utilizing your dental care. This will show the applicable copays
that apply to all of the dental services that are covered under this plan.

Guardian | PPO
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 Choice Plan NAP/Value network 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 DHMO PPO
Network Name Managed Dental Care Choice Plan NAP/Value Non-Network
Dental Benefits

Office Visit Copay $5 Copay $0 Copay $0 Copay
Calendar Year Maximum Unlimited $1,500 $1,500

Calendar Year Deductible
- Individual $0 $50 $50
- Family $0 3 per Family 3 per Family

Preventive No Charge for Most Services No Charge No Charge*
Basic Services See Copay Schedule Deductible, No Charge Deductible, 20%*
Major Services See Copay Schedule Deductible, 40% Deductible, 50%*

Orthodontia
- Child $1,895 Copay 50% with $1,895 Lifetime Maximum Benefit
- Adult $2,195 Copay 50% with $2,195 Lifetime Maximum Benefit
*Dentists who are out-of-network have not agreed to pricing, and may bill you for the difference between what Guardian pays
them and what the dentist usually charges.

Finding a Dental Provider
Go to www.guardiananytime.com or call (888) 600-1600.
DHMO → Managed Dental Care network
PPO → Choice Plan NAP/Value network

Note
We 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.

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