Dental Plan
Group Number 434378
Benefit Period January 1, 2024 – December 31, 2024
Your dental coverage is through Guardian and the dental network is Dental Guard Preferred. Network dentists agree to accept Guardian’s usual, customary & reasonable (UCR) amounts as payment in full for covered services. Non-network dentists will bill you for any difference in cost between the Guardian scheduled amount and the dentist’s fee (balance billing).
To avoid balance billing you should select providers within the network. Frequency limitations apply to certain services.
RESOURCES
Base Plan
| Dental Benefit Provisions | PPO Network | PPO Non-Network |
| Calendar Year Deductible | None | None |
| Class I – Preventive Care Oral Exams, Prophylaxis (dental cleaning), Bitewing X-rays, Full Mouth X-Rays, Sealants |
100% | 100% of Prevailing Fee |
| Class II – Basic Care Fillings (one surface), General Anesthesia, Scaling & Root Planing (per quadrant), Simple Extractions |
100% | 100% of Prevailing Fee |
| Class III – Major Care Dentures, Single Crowns, Implants |
60% | 60% of Prevailing Fee |
|
Class IV – Orthodontic Procedure |
60% | 60% of Prevailing Fee |
|
Orthodontic Lifetime Maximum |
$2,500 | $2,500 |
|
Annual Yearly Maximum (Per Person) |
$1,500 | $1,500 |
How to Find a Dentist:
- Go to www.guardiananytime.com/fpapp/FPWeb
- Click “Search Providers”
- Make sure you are on the “Find a Dentist” tab
- Select Plan Type “PPO”
- Enter your information
- Click on “Search”
Pre-determination Review
Guardian will gladly assist you and your dentist by determining what benefits could be payable for services and procedures over $300. Have your dentist fax your treatment plan to Guardian, note that it is a pre-determination review and we will let your dentist know what benefits would be payable.
