Dental Insurance

An in-network dentist has a contractual agreement with Guardian to provide dental care to our members at more affordable rates. Visiting an in-network dentist can save you up to 35% off standard rates for dental services. An added benefit of using an in-network dentist is you won't need to submit any claim forms. The in-network dentist submits all dental claim forms directly to Guardian on your behalf.

For Guardian Dental Advantage Gold, Silver, and Bronze (PPO) plans, members who visit an in-network dentist will not be charged more than the contracted rate even when the dentist's normal rate is higher. With PPO plans, you also have the choice of visiting an out-of-network dentist. Note that an out-of-network dentist may charge their regular rates for services, but Guardian will only pay a standard amount, calculated according to the requirements of your state. You will be responsible for the difference.

For Guardian Dental Managed DentalGuard (DHMO) plans, you must choose one in-network DHMO dentist who serves as your primary care dentist. All care must be provided or arranged by your primary care dentist. If you do not choose a primary care dentist, a dentist in your area will be assigned to you. There is no out-of-network coverage. 

Guardian has an easy to use tool to help you find a dentist participating with your plan: Find a Dentist. Each member of your family covered on your plan can choose their own dentist.

For Guardian Dental Advantage Gold, Silver, and Bronze (PPO) plans, you can choose any in-network dentist participating in you plan. You are not limited to just one dentist in the network, and you can change your dentist as often as you like.

For Guardian Dental Managed DentalGuard (DHMO) plans, you must choose one in-network DHMO dentist who serves as your primary care dentist. If you do not choose a primary care dentist, a dentist in your area will be assigned to you. All care must be provided or arranged by your primary care dentist. If you decide that you would like to change your primary care dentist, you have the option to make a change once per month. (See “How do I change my dentist?’) 

No. Each member of your family covered on your plan can choose their own dentist.

PPO stands for Preferred Provider Organization. Guardian Dental Advantage Gold, Silver, and Bronze plans are PPO plans. Here's how PPO plans work:

Choosing a Dentist

When you choose an in-network dentist, Guardian’s negotiated rates can save you up to 35% off dentists’ typical charges. Members who visit an in-network dentist will not be charged more than the contracted rate even when the dentist's normal rate is higher. An added benefit of using an in-network dentist is you won't need to submit any claim forms. The in-network dentist submits all dental claim forms directly to Guardian on your behalf.

When you choose an out-of-network dentist, you may be charged their regular rates for services. Guardian will only pay a standard amount, calculated according to the requirements of your state. You will be responsible for the difference.

What Guardian Pays

Guardian pays a percentage of dentist's charges by category of service (e.g. preventive, basic, major). You are responsible for the remainder of the dentist's charges.

The types of services covered and the percent of the dentist's charges that Guardian pays varies by plan color (Gold = higher, Silver = medium, Bronze = lower).

Waiting Periods

A waiting period is the time period following your coverage start date during which no benefits are paid. There are no waiting periods for preventive care, such as cleanings, exams, and x-rays. Basic services such as fillings and simple extractions have a waiting period of 6 months or less, depending on your state. Major dental work such as root canals, crowns, implants, and kids’ braces have a waiting period of 12 months or less, depending on your state.

Deductibles and Maximums

A deductible is the dollar amount that you're responsible for paying before the insurance plan will start to pay benefits. There is no deductible for preventive care if you use an in-network dentist. There is a $50 deductible for all other dental care.

There is a maximum dollar payout for each benefit year.  The maximum increases in year 2 and year 3, recognizing your loyalty. 

DHMO stands for Dental Health Maintenance Organization. Guardian Dental Managed DentalGuard plans are DHMO plans. Here's how DHMO plans work:

Choosing a Dentist

You must choose one in-network dentist from the smaller DHMO network who will serve as your primary care dentist.

If you do not choose a primary care dentist, a dentist in your area will be assigned to you. All care must be provided or arranged by your primary care dentist. There is no out-of-network coverage.

What Guardian Pays

Guardian pays the difference between the total cost of dental services and your office visit charge + copay.

You pay a small office visit charge (typically $15-$18) plus a copay amount associated with each type of covered treatment. Note: A list of each covered treatment and its associated copay can be found in your Plan Summary and also in your policy documents.

With a DHMO program, you know exactly what you will be responsible for paying before you visit the dentist.

There are no claim forms to submit.

Waiting Periods

A waiting period is the time period following your coverage start date during which no benefits are paid. There are no waiting periods.

Deductibles and Maximums

A deductible is the dollar amount that you're responsible for paying before the insurance plan will start to pay benefits. There are no deductibles.

There is no maximum dollar payout for each benefit year. 

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.

 

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