DENTAL

DENTAL

Dental – Core HMO and Buy-Up

Select Guardian and choose providers from one of the largest Preferred Provider Networks with over 200,000 locations. Out-of-pocket costs are likely to be less when you choose an in-network dentist.

100% coverage for oral exams, every 6 months
No annual deductible on either plan options
Orthodontic benefit available with the Buy-Up PPO Plan for Children Only

Resources

Guardian - Dental Benefit Summary

Dental Buy-Up PPO Plan

Dental Buy-Up PPO Plan	In-Network
Annual Deductible (Individual/Family)	$0
Annual Maximum	$1,000
Orthodontic – Dependent Children	60%
Orthodontic – Adults	Not Covered
Preventive / Diagnostic Services	100
Basic Services	90%
Major Services	70%
Orthodontic Services	60%

Employee Cost Per Pay	Full Time Employees	Part Time Employees
Employee Only	$0.00	$0.00
Family – management / exempt	$0.00	$0.00
Family – bargaining unit	$5.00	$9.36

Dental Core HMO Plan

Dental Buy-Up PPO Plan	In-Network
Annual Deductible (Individual/Family)	$0
Annual Maximum	Unlimited
Orthodontic – Dependent Children	Not Covered
Orthodontic – Adults	Not Covered
Preventive / Diagnostic Services	100%
Basic Services	Fee Schedule
Major Services	Fee Schedule

Employee Cost Per Pay	Full Time Employees	Part Time Employees
Employee Only	$0.00	$0.00
Family – management / exempt	$0.00	$0.00
Family – bargaining unit	$0.00	$0.00