Page 11 - Burnham Benefits Guide 2017

DENTAL INSURANCE

The Guardian Preferred Provider Organization (PPO) Dental plan covers a wide range of dental services. 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
paying the difference between the covered amount and the actual charges and you may be responsible for filing claims.

Guardian
Plan Features PPO Dental Plan
DentalGuard
Network Preferred PPO Non-Network
Calendar Year Maximum Benefit $1,500
Annual Deductible
Individual $50 $75
Family 3 Per Family 3 Per Family
Preventive Services (Plan Pays) 100% 100%
Deductible Waived Yes No
Cleaning Frequency Once Every 6 Months Combined
Basic Services (Plan Pays) 80% 80%
Major Services (Plan Pays) 50% 50%
Orthodontia (Adult & Child) 50%; $1,500 Lifetime Maximum

FINDING A DENTAL PROVIDER:
• Guardian PPO: Log into www.guardiananytime.com or call (800) 541-7846. Refer to the “DentalGuard Preferred
PPO” network
TIPS FOR USING YOUR DENTAL PLAN WISELY

1 Dental ID cards are not required to obtain dental services.
When visiting a Guardian DentalGuard Preferred PPO dentist simply provide your social security number. The
dental office can use that information to verify your eligibility and benefits.
2 Utilize contracted network providers when possible.

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.
3 Ask for a predetermination of benefits.

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.
4 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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