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Dental

Individual dental insurance products are underwritten by The Guardian Life Insurance Company of America, New York, New York or by one of its wholly owned subsidiaries. Products are not available in all states. Policy limitations and exclusions apply. The actual limitations and exclusions that apply to your Dental Plan are governed by the policy forms approved for use in your state. Please refer to your policy for a complete list of limitations and exclusions. In the event of a conflict between this document and the language stated in your Guardian insurance policy, the language of the policy shall control. This policy provides DENTAL insurance only.

Dental provider networks vary by state, by market and by plan type

Rates are guaranteed for one year for your policy of benefits initially selected. Policies renew annually.

IMPORTANT INFORMATION ABOUT GUARDIAN’S DENTALGUARD INDEMNITY AND DENTALGUARD PREFERRED PPO PLANS

Dental PPO plans provide in-network and out-of-network benefits. Use of an in-network provider may result in reduce out of pocket costs.

Coverage is limited to those charges that are necessary to prevent, diagnose or treat dental disease, defect, or injury. Deductibles apply. Waiting periods may also apply for some services

Individual dental plans do not pay for: oral hygiene services (except as covered under preventive services), orthodontia (unless expressly provided for), cosmetic or experimental treatments, any treatment to the extent benefits are payable by any other payor or for which no charge is made, prosthetic devices unless certain conditions are met, and services ancillary to surgical treatment.

Individual dental plans limit benefits for diagnostic consultations and for preventive, restorative, endodontic, periodontic and prosthodontic services.

Listed services, exclusions and limitations do not constitute a contract and are a summary only.

IMPORTANT INFORMATION REGARDING DENTAL HMO BENEFITS

Dental HMOs provide Pre-Paid dental benefits through a network of participating general dentists and specialty care dentists. All covered services must be provided by the member’s Primary Care Dentist. Specialty care services are covered only when referred by the member’s Primary Care Dentist and approved in advance by the Dental DHMO.

Only those services listed in the Dental HMO plan are covered. Certain services are subject to annual or other periodic limitations. Where orthodontic benefits are specifically included, your policy provides for one course of comprehensive treatment per lifetime, per member. Dental HMOs do not provide orthodontic benefits if comprehensive orthodontic treatment or retention is in progress as of the member’s effective date. Listed services, exclusions and limitations do not constitute a contract and are a summary only.

Products Underwritten by Guardian Life Insurance Company of America

DENTAL PPO PLANS  Policy Form IP-DEN-16 ET. AL.

DENTAL HMO PLANS

      FLORIDA              Policy Form IP-1-MDG-DHMO-FL-OFF-17

      NEW YORK          Policy Form IP-MDG-NY-FP-OFF-17

 

Products Underwritten by Managed Dental Guard, Inc.

DENTAL HMO PLANS

      TEXAS                 Policy: IP-1-MDG-DHMO-TX-17

 

Products Underwritten by First Commonwealth Inc. through its Illinois subsidiaries*

DENTAL HMO PLANS

      ILLINOIS             Policy: IP-FCW-DHMO-IL-17

*First Commonwealth Insurance Company — (IL), First Commonwealth Limited Health Services Corporation — (IL), First Commonwealth of Illinois, Inc.

 

Vision

Vision insurance is provided by VSP and billing and premium collection services for such vision insurance are conducted by DTC GLIC, LLC (d/b/a DTC GLIC Insurance Sales, LLC in California). DTC GLIC, LLC is a wholly owned subsidiary of The Guardian Life Insurance Company of America ("Guardian").

Guardian and DTC GLIC, LLC are not affiliated with VSP and Guardian and DTC GLIC, LLC do not assume any responsibility or liability for non-Guardian products or services, including those offered by VSP.

 

TruHearing®

TruHearing’s digital hearing aid discount plan is available to VSP members and is not insurance. TruHearing is an independent third party not affiliated with Guardian.  The discounts for hearing aids are available only from participating TruHearing providers and will vary depending on the provider or service received. TruHearing does not make payments to providers for the services received under the discount plan. You are obligated to pay for all medical or ancillary services but will receive a discount from those TruHearing providers that have contracted with Truhearing.  VSP does not provide or operate any discount hearing program. The relationship between VSP and TruHearing is that of independent contractors. VSP makes no endorsement, representations or warranties regarding any products or services offered by TruHearing, a third-party vendor. The vendor is solely responsible for the products or services offered by them. Not available in WA, UT, MD or CA. To obtain additional information  go to TruHearing.com or call 1-844-571-9952.

VSP is providing information to its members but does not offer or provide any discount hearing program. The relationship between VSP and TruHearing is that of independent contractors. VSP makes no endorsement, representations or warranties regarding any products or services offered by TruHearing, a third-party vendor. The vendor is solely responsible for the products or services offered by them. If you have any questions regarding the services offered here, you should contact the vendor directly.

TruHearing offers individuals the opportunity to purchase hearing aids at discounted prices, including individuals covered by self-funded health plans not subject to state insurance or health plan regulations. TruHearing is not insurance and not subject to state insurance regulations. TruHearing provides discounts to certain health care groups for hearing aid sales and services; TruHearing provides fitting, programming and three adjustment visits at no cost; the member is obligated to pay for testing, and all post-fitting hearing care services, but will receive a discount from those health care providers who have contracted with TruHearing. Not available directly from VSP in WA, UT, MD or CA.

 

Accident

Individual accident insurance products are underwritten by The Guardian Life Insurance Company of America, New York, New York. Products are not available in all states. Policy limitations and exclusions apply. The actual limitations and exclusions that apply to your Accident Plan are governed by the policy forms approved for use in your state. Please refer to your policy for a complete list of limitations and exclusions. In the event of a conflict between this document and the language stated in your Guardian insurance policy, the language of the policy shall control. This policy provides limited benefits only.

Guardian Direct plans are underwritten and issued by The Guardian Life Insurance Company of America New Your, N.Y. or its subsidiaries. Products are not available in all states. Policy limitations and exclusions apply. In the event of a conflict between this document and the language stated in your Guardian insurance policy, the language of the policy shall control. 

Rates are guaranteed for one year for your policy of benefits initially selected. Policies renew annually up to age 90.

Accident Individual Policy Form IP- Accident: IP-ACC-16 et. al.

Critical Illness

Individual Critical Illness insurance products are underwritten by The Guardian Life Insurance Company of America, New York, New York. Products are not available in all states. Policy limitations and exclusions apply. The actual limitations and exclusions that apply to your Critical Illness Plan are governed by the policy forms approved for use in your state. Please refer to your policy for a complete list of limitations and exclusions. In the event of a conflict between this document and the language stated in your Guardian insurance policy, the language of the policy shall control. This policy provides limited benefits only.

Rates are guaranteed for one year for your policy of benefits initially selected. Policies renew annually up to age 75.

Critical Illness Individual Policy Form IP-CI-16 et. al.

New Mexico Residents - Important Notice

The coverage provided under your benefits plan or policy underwritten by Guardian is limited in nature and may not provide financial protection for significant costs that you could incur for the diagnosis or treatment of COVID-19 ("Corona virus") related illness.

If you do not have comprehensive major medical coverage, in addition to the plan or policy issued by our company, you may incur significant uninsured medical expenses associated with the diagnosis and treatment of illness caused by COVID-19.

Major medical plans offer robust consumer protections, and are required to waive all deductibles, co-pays and other cost sharing expenses for the diagnosis or treatment of COVID-19 related illness. Your policy or plan with us is not a major medical plan and does not provide such protections.

If you do not have major medical coverage, you may:

1. Contact a licensed insurance broker or agent to see about major medical coverage availability.

2. To see if you are eligible for a special enrollment period for major medical coverage through the New Mexico Health Insurance Exchange, contact beWellnm toll-free at 1-833-862-3935.

3. To see if you are eligible for Medicaid coverage and to complete an application, please call the Human Services Department's Medicaid Expansion Hotline toll-free at l-855-637-6574 or visit https://www.yes.state.nm.us/yesnm/home/index.

4. To see if you are eligible for high risk pool coverage, please contact the New Mexico Medical Insurance Pool (the "High Risk Pool") at 1-844-728-7896 or https://nmmip.org/. If you are uninsured and have a COVID-19 diagnosis, your condition qualifies you for Pool coverage.

The Centers for Disease Control and the New Mexico Department of Health each have websites with considerable information on COVID-19. Visit each website at https://www.cdc.gov/ or http://cv.nmhealth.org/. Individuals who have symptoms consistent with COVID-19 should immediately call the NM Department of Health at 1-855-600-3453.

 

Information on the approved state and product specific online enrollment form numbers can be viewed here: Online Enrollment Form Numbers