Dental
Healthy teeth and gums are an important part of good overall health. That’s why the Health Plan provides dental coverage and offers you the flexibility of seeing any dentist you’d like.
When you visit a dentist in Guardian’s DentalGuard Preferred Select PPO network, you’ll pay less for care because network dentists discount their fees.
Highlights
- Preventive care and diagnostic services: No deductible applies; covered 100% in-network
- Annual deductible: $50 per person; $100 per family (doesn’t apply to in-network diagnostic and preventive care)
- Annual maximum benefit (excluding orthodontia): $2,000 per covered person for Type II and Type III services; $2,000 per covered person for dental implant procedures; no annual maximum benefit for covered children age 18 or under
- Lifetime maximum orthodontia benefit: $2,500 per covered person
- Lifetime temporomandibular joint dysfunction (TMJ) benefit: $1,500 per covered person
| Dental Care | In-Network (you pay) | Out-of-Network (you pay) |
|---|---|---|
| Type I: Diagnostic/preventive (e.g., annual cleanings, routine X-rays) | $0 | 100% of amount over UCR* rate |
| Type II: Minor restorative (e.g., fillings, extractions, endodontics, periodontics) | 20% of PPO contracted rate after deductible | 20% after deductible, plus the difference between UCR* and the amount your provider charges |
| Type III: Major restorative (e.g., crowns, bridgework, dentures, implants, inlays) | 30% of PPO contracted rate after deductible | 30% after deductible, plus the difference between UCR* and the amount your provider charges |
| Dental Implant Procedures | 30% of PPO contracted rate after deductible | 30% after deductible, plus the difference between UCR* and the amount your provider charges |
| Orthodontia | Benefits are paid up to the $2,500 lifetime benefit maximum in equal installments while in active treatment every 90 days for up to two years. Lifetime benefit maximum does not apply to pediatric medically necessary orthodontia. | |
* The UCR rate is the amount paid for a dental service in a geographic area based on the amount providers in that area usually charge for the same or similar dental service. You also pay 100% of any amount over UCR that an out-of-network provider charges.
What you need to do
- Use Guardian network providers whenever you can.
- Visit Guardian and select the Guardian DentalGuard Preferred Select network or call 888-600-9200 to find network providers.
