With Guardian’s PPO option, you can see any dentist you want but save more when you visit a dentist that participates in Guardian’s DentalGuard Preferred network. As one of the largest nationwide networks on and off the health insurance marketplace, chances are your dentist is already a participant. Charges for services provided by participating dentists are based on negotiated, discounted fee schedules, and are reimbursed directly from Guardian. If you choose to see a dentist outside of the network, you’ll be reimbursed based on the lower of your dentist’s fees, or the maximum allowable charge, which is the amount that would be paid to dentists who have agreed to be reimbursed according to a negotiated fee schedule. You would be responsible for any amounts over the maximum allowable charge as well as any co-insurance.
|Guardian Family Essentials PPO Benefits — 2016 Plan Year|
What you pay out-of-pocket before the plan pays benefits
|Waived for Preventive Care||No||No|
|Out of Pocket Maximum – Applies to members under 19 only
Once this amount is reached, Guardian will pay 100% of your child’s dental charges for the rest of the year
|Individual (One Child)||$350||n/a|
|Family (2+ Children)||$700||n/a|
The maximum amount that you can be reimbursed for services received
Applies to members 19 and over*
The amount Guardian pays toward the cost of a covered charge
Most routine dental services, including:
oral exams, cleanings, x-rays
Moderately complex dental services,
including fillings, and simple extractions
More complex dental services including:
crowns, complex extractions, oral surgery,
periodontal and endodontic services
|Medically Necessary Orthodontia
Applies to members under age 19 only
The initial time period following enrollment for which no benefits would be paid
Applies to members 19 and older
|6 months||6 months|
Applies to members 19 and older
|12 months||12 months|
|Medically Necessary Orthodontia||24 months||24 months|
*Annual maximums may apply to children under 19 for services that are not included in the pediatric essential health benefit
Coverage is limited to charges that are necessary to prevent, diagnose or treat dental disease, defect or injury. Depending on plan type, deductibles, waiting periods, per service frequency limitations, and payment limits may apply.
The list of dental services illustrated are not exhaustive. Please refer to a certificate of coverage for full plan description, the list of covered dental services and plan exclusions and limitations (noted below).
This plan does not pay for:
Guardian Dental is underwritten by The Guardian Life Insurance Company of America, New York, NY. Policy limitations and exclusions apply. Plan documents are the final arbiter of coverage.
Plans are not available in the following counties: Adams, Alexander, Bond, Brown, Bureau, Calhoun, Carroll, Cass, Champaign, Christian, Clark, Clay, Clinton, Coles, Crawford, Cumberland, Dewitt, Douglas, Edgar, Edwards, Effingham, Fayette, Ford, Franklin, Fulton, Gallatin, Greene, Hamilton, Hancock, Hardin, Henderson, Henry, Iroquois, Jackson, Jasper, Jefferson, Jo Daviess, Johnson, Knox, La Salle, Lawrence, Lee, Livingston, Logan, Macon, Macoupin, Marion, Marshall, Mason, Massac, Mcdonough, Mclean, Menard, Mercer, Montgomery, Morgan, Moultrie, Peoria, Perry, Piatt, Pike, Pope, Pulaski, Putnam, Randolph, Richland, Rock Island, Saline, Sangamon, Schuyler, Scott, Shelby, Stark, Stephenson, Tazewell, Union, Vermilion, Wabash, Warren, Washington, Wayne, White, Whiteside, Williamson, Woodford
Guardian has been a trusted name in insurance for over 155 years. Today, we have one of the largest dental insurance networks in the country and our dentists can help you with significant savings on the dental care you need* Learn More About Guardian
Whether you're looking for a new plan or are an existing member, we're here to help.