Page 13 - Ria Benefits Guide 2020 FINAL CA

DENTAL PLANS

Guardian Dental Plan Choices

GUARDIAN | DHMO PLAN
With your DHMO plan, you enjoy negotiated discounts from our network dentists. You pay a fixed copay for each
covered service Guardian offers. Out-of-network visits are not covered. The Managed Care DHMO plan is offered to
employees located in California, Texas, Colorado, New Jersey, New York and Florida. The Managed Dental Care plan
requires the selection of a Primary Care Dentist (PCD) from the Guardian Managed Care network at the time of
enrollment. You must use this dentist to receive care, and care is provided requiring a fixed copay for each services.

GUARDIAN | PPO LOW AND HIGH PLAN
With your PPO Low or PPO High plan, you can visit any dentist; but you pay less out-of-pocket when you choose an In-
Network PPO dentist. Out-of-network benefits are limited to our PPO fee schedule. The Dental Low and High PPO plans
are offered to employees in all locations. The Dental Preferred Organization (DPO) gives you access to a network of
dentists that have agreed to a discount payment schedule. You are not required to designate a Primary Care Dentist, and
you have the choice to select any participating Guardian PPO dentist. You may choose to obtain services from a non-
network provider; however, your out-of-pocket costs will be higher and your annual maximum benefit will
be lower.

DENTAL MAXIMUM ROLLOVER
(Save dental funds for use in the future)
If you are enrolled in either the Low PPO or High PPO plans, Guardian will roll over a portion of your unused annual
maximum into your personal Maximum Rollover Account (MRA). Any rollover amount will be credited based on activity
through December 31st.

To qualify you must:
1. Have a paid claim (not just a visit)
2. Not to exceed the $500 paid claim threshold during the benefit year.

• If you qualify and use in-network dentists you are eligible to receive a rollover of $350 or $250 if you receive services
from a non-network dentist.
• Your MRA may not exceed the $1,000 MRA limit.
• Employees can determine status of MRA account by using the link on www.GuardianAnytime.com. MRA status is also
noted on each explanation of benefits (EOB).

NOTE:
We strongly recommend you ask your
dentist for a predetermination if total FINDING A DENTAL PROVIDER:
charges are expected to exceed $300.
Predetermination enables you and your Contact Guardian member services at 1-800-551-7846 for Dental PPO or 1-888-
dentist to know in advance what the 618-2016 for DHMO
payment will be for any service that Go to www.guardiananytime.com and click on “Find a Provider,” select dental
may be in question. and enter a zip code
• For the DHMO, select Managed Dental Care (DHMO/Prepaid)
• For the Low or High PPO, select Dental PPO

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