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Dental Plan

Group Number 434378

Benefit Period January 1, 2022 – December 31, 2022

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.

Base Plan

Dental Benefit Provisions In-Network Out-of-Network
Calendar Year Deductible (Single/Family) None None
Class I – Preventive Services
Emergency Palliative Treatment, Fluoride Treatments, Oral Examination, Periodontal Maintenance Procedure, Space Maintainers, Teeth Cleaning, Topical Sealants, X-Rays
100% covered 100% of usual, reasonable, and customary rates for a given area
Class II – Basic Services
Endodontic Services/Root Canal Therapy,  Fillings, General Anesthesia (surgical procedures only), Oral Surgery, Periodontal Services, Repairs of dentures, bridgework, crowns, etc.
100% covered 100% of usual, reasonable, and customary rates for a given area
Class III – Major Services
Bridges Installation, Crowns: Five Year Replacement, Dentures (Full and Partial), Implants, Inlays, Onlays, Posts
60% covered 60% of usual, reasonable, and customary rates for a given area

Class D – Orthodontic Services
Procedures for Adults and Children

60% covered 60% of usual, reasonable, and customary rates for a given area

Orthodontic Lifetime Maximum

$2,500 $2,500

Calendar Year Maximum (Per Person) Applies to Class I, Class II & Class III services combined

$1,500 $1,500

How to Find a Dentist:

  1. Go to www.guardiananytime.com/fpapp/FPWeb
  2. Click “Search Providers”
  3. Make sure you are on the “Find a Dentist” tab
  4. Select Plan Type “PPO”
  5. Enter your information
  6. 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.