Cheat Sheet

Insurance 101: Your Official Cheat Sheet

Insurance can be confusing. We’re here to help make it easier.

Let’s start with the basics

Waiting Period – This is the period of time that begins after your coverage start date, but before benefits are paid (aka how long you have to wait before your plan will cover certain services). Here’s what that can actually look like: 

• Preventive Care: No waiting period! Preventive care practices like cleanings, exams, and X-rays are covered on Day 1. 

• Basic Care: Basic services, like fillings and simple extractions, have a waiting period of 6 months (or less, depending on your state).  

• Major Care: Major dental work—like root canals, crowns, implants, and kids’ braces—has a 12-month waiting period (or less, depending on your state). 

Effective Date – An effective date is the day you can start using your benefits. This will be determined by 1) your enrollment date, and 2) your payment method. 

Deductible – A deductible is the dollar amount you’re responsible for paying before your insurance plan starts to pay benefits.  

Co-pay – A copayment is a fixed dollar amount (based on the type of dental service you receive) that you’ll have to pay at the time of your service. 

Co-insurance – Once you’ve paid your plan’s deductible, coinsurance is how much you owe for a dental service after the percentage paid by Guardian.  

Explanation of Benefits (EOB) – An EOB is the document that shows the outcome of a claim. It explains which services were paid by Guardian under your plan. (Not a bill!) 

All about our Dental plans

How many plans do you offer? 

We offer four levels of coverage: Starter, Core, Achiever, and Diamond.

Starter: Our Starter plan brings you no-fuss coverage to keep up on preventive care, cleanings, and X-rays. 

Core: Want reliable coverage, but don’t need everything? Our Core plan was made with you in mind. 

Achiever: Full coverage, right this way. Our Achiever plan gets you our complete collection of care benefits in one. 

Diamond: Care meets confidence in our Diamond plan. Get ready for the full coverage you love, now with teeth whitening! 

Do you offer PPO plans or DHMO plans?

We offer PPO plans right here on guardiandirect.com. You can find our DHMO plans on the Exchange Marketplace (available in Illinois, Florida, New York, and Texas).  

What’s the difference between preventive care, basic care, and major care? 

Preventive Care: Oral exams, cleanings, and X-rays. No waiting period! 

Basic Care: Fillings and simple extractions. These have a 6-month waiting period (or less, depending on your state). 

Major Care: Crowns, complex extractions, oral surgery, root canals, implants, kids’ braces, and more. These have a 12-month waiting period (or less, depending on your state). 

Do your plans cover implants and dentures?

Yes! Our Core, Achiever, and Diamond plans can cover up to 50% of implants and denture costs after a 12-month waiting period (or less, depending on your state). 

Is this the Guardian Dental Exchange? 

No, you can find the Guardian Dental Exchange on the Exchange Marketplace.

Get the most out of your membership

Do I need to register?

Yes! After you make your first purchase, you’ll still need to register in order to access your Guardian Direct Member Dashboard. 

How can I manage my policy? How will I receive my policy documents? Where can I look up my EOB?

Everything you need can be found in your Member Dashboard! Sign in to view, manage, and print all of your policy details and documents. 

Where is my Dental ID card?

You’ll receive a paper copy of your Dental ID card with your welcome letter (which should arrive 7-10 days after enrollment). You can view a digital copy in your Member Dashboard.  

How can I change my method of payment?

Easy! Sign in to your Guardian Direct Member Dashboard and click on the Billing & Payments tab. You can update your payment method by selecting Update Payment Settings. Feel free to call our Customer Care team at (866) 569-9900—we’re here to help! Our service center is open Monday through Friday from 9am-9pm ET.

Can I cancel my membership?

You can terminate your plan at any time—you decide! Your termination can become effective on 1) The last day of the month during which the request is made, or 2) The last day of the month during which the premium has been received. The request must come from the main subscriber (aka member) of the policy. Once you cancel your Dental PPO plan, you’ll have to finish a 12-month waiting period before you’re able to re-enroll. 

Still curious?

Head over to our FAQ page to explore more of our most popular Q&As.

Want to talk to a (real) person? 

Click here to get in touch with our Customer Care team.