Dental Benefits

Name: Spotlight Analyst Relations
Address: United States

Dental insurance offers coverage for preventive care like routine exams, cleanings, and X-rays as well as basic and major services like fillings, extractions, root canals and crowns. To find an in-network dentist, please visit www.guardianlife.com.

DentalGuard Preferred Network	Base Plan Tier 1 Gold, Silver	Base Plan Tier 1 Non-Contracted	Buy-Up Plan Tier 1 Gold, Silver	Buy-Up Plan Tier 1 90% UCR
Calendar Year Deductible	Tier 1	Tier 2	Tier 1	Tier 2
Individual	$50	$50	$50	$50
Family Limit	3 per family (applies to all levels)	3 per family (applies to all levels)	3 per family (applies to all levels)	3 per family (applies to all levels)
Waived for	Preventive	Preventive	Preventive	Preventive
Charges Covered for You (Co-Insurance)	Tier 1	Tier 2	Tier 1	Tier 2
Preventive Care	100%	100%	100%	100%
Basic Care	80%	80%	90%	90%
Major Care	50%	50%	60%	60%
Orthodontia	Not Covered (applies to all levels)	Not Covered (applies to all levels)	50%	50%
Annual Maximum Benefit	$1,000	$1,000	$1,500	$1,500
Maximum Rollover	Yes (applies to all levels)	Yes (applies to all levels)	Yes (applies to all levels)	Yes (applies to all levels)
Rollover Threshold	$500	$500	$700	$700
Rollover Amount	$250	$250	$350	$350
Rollover Amount	$350	$350	$500	$500
Rollover Account Limit	$1,000	$1,000	$1,250	$1,250
Lifetime Orthodontia Maximum	N/A (applies to all levels)	N/A (applies to all levels)	$1,000 (applies to all levels)	$1,000 (applies to all levels)
Dependent Age Limits	26 (applies to all levels)	26 (applies to all levels)	26 (applies to all levels)	26 (applies to all levels)
A Sample of Services Covered by your Plan:	Tier 1	Tier 2	Tier 1	Tier 2
Preventive Care: Cleaning Frequency Flouride Treatments Limits Oral Exams Sealants (per tooth) X-Rays	100% Once every 6 months 100% Under age 19 100% 100% 100%	100% Once every 6 months 100% Under age 19 100% 100% 100%	100% 2 in 2 months 100% Under age 19 100% 100% 100%	100% 2 in 2 months 100% Under age 19 100% 100% 100%
Basic Care: Anesthesia Filings Perio Surgery Peridontal Maintenance Frequency Root Canal Scaling & Root Planing Simple Extractions Surgical Extractions	80% 80% 50% 50% Once every 6 months 50% 50% 80% 80%	80% 80% 50% 50% Once every 6 months 50% 50% 80% 80%	90% 90% 90% 90% 2 in 2 months 90% 90% 90% 90%	90% 90% 90% 90% 2 in 2 months 90% 90% 90% 90%
Major Care: Bridges & Dentures Inlays, Onlays, Veneers Repair & Maintenance of Crowns, Bridges & Dentures Single Crowns	50% 50% 50% 50%	50% 50% 50% 50%	60% 60% 60% 60%	60% 60% 60% 60%
Orthodontia: Orthodontia Limits	Not Covered all levels	Not Covered all levels	50% Child(ren) all levels	50% Child(ren) all levels

Per Pay Period Cost	Base Plan	Buy-Up Plan
Employee Only	$16.71	$22.59
Employee + Spouse	$33.42	$45.20
Employee + Child(ren)	$36.00	$53.01
Family	$55.28	$79.65

Group Number

00024395

Provided By

Guardian

Provider Website

www.guardianlife.com

Customer Service

888.600.1600

Resources

Frequently Asked Questions