This plans offered by Group Benefit Associates and insured by Guardian gives members the opportunity to choose either a Dental PPO Plan or a Dental DHMO Plan. Both plans offer great coverage and the flexibility allows you to select the plan that best fits your specific needs and budget. The Dental DHMO Plan is offered in California, Colorado, Florida, Illinois, Indiana, Michigan, Missouri, New Jersey, New York, and Ohio. The Dental PPO Plan is offered in all 50 states.
The Dental PPO plan allows you to visit any dentist or specialist you choose any time care is needed. If you elect to visit a Guardian network provider, you will receive the highest level of benefits and save on out-of-pocket costs. Best of all, the Guardian Dental PPO Plan features one of the industry’s most extensive nationwide dental networks with over 77,000 provider locations.
- Cost Effective: Guardian network dentist negotiated fee discounts up to 30% less than the average charges in the same community.
- High Satisfaction: 97% satisfaction rate among members who have seen a dentist.
- Maximum Rollover: Guardian’s innovative plan feature which allows you to roll over unused dental premium for use in the future.
The plan pays a specific amount for each dental service based upon an established fee schedule. If you go to a Guardian Dental PPO provider, the benefits described below apply. Out-of-network benefits are limited to the PPO fee schedule.
With the DHMO plan, you enjoy negotiated discounts from our network dentists. You pay a fixed copay for each covered service. Out-of-network visits are not covered.
DHMO & PPO Plan Comparison
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DHMO
|
PPO
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Dental Network
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First Commonwealth
|
Dental Guard Preferred
|
Calendar Year Deductible
(waived for Preventive services) |
No Deductible
|
$50
|
Annual Maximum Benefit
|
Unlimited
|
$1,000
|
Preventive Services
Exams, Cleanings, X-Rays, Fluoride Treatments, Sealants |
$0
|
100% of fee schedule
|
Basic Services
Fillings, Perio Surgery, Periodontal Maintenance, Root Canal, Simple Extractions |
Copay*
|
80% of fee schedule
|
Major Services
New Bridges & Dentures, Dental Implants, Inlays, Crown, Bridges, Denture Repair & Maintenance, Surgical Extractions |
Copay*
|
50% of fee schedule
|
Orthodontia
|
Copay*
|
not covered
|
Cosmetic Bleaching
|
$165
|
not covered
|
Office Visit Copay
|
$5
|
none
|
Dependent Age Limits (Non-Veteran/Veteran)
|
26/30**
|
26/30**
|
PRE-DETERMINATION: When a course of treatment is expected to cost $300 or more and is of a non-emergency nature, it is recommended to have your dentist submit a treatment plan before he/she begins.
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This is intended only as a brief summary of benefits and is only a partial list of services. It is not an official statement of those benefits. Please See Plan Details Tab for more information.
*DHMO Copayment Schedules are available on the “Plan Details” section of our web site.
**Coverage for unmarried dependents is extended to age 30 for Illinois residents with prior military service receiving an honorable discharge.
Eye care is a vital component of a healthy lifestyle. With Vision Insurance, having regular exams and purchasing contacts or glasses is simple and affordable.
This option allows you to visit any doctor, but save by visiting any of the 50,000+ locations in the nations largest vision network.
Vision Plan
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Full Feature
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Vision Network
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VSP Choice
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Exam Copay
|
$10
|
Materials Copay (Waived for non-formulary elective contact lenses)
|
$25
|
Eye Exams (in network / out of network)
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$0/Amt over $39
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Single Vision Lenses (in network / out of network)
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$0/Amt over $23
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Lined Bifocal Lenses (in network / out of network)
|
$0/Amt over $37
|
Lined Trifocal Lenses (in network / out of network)
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$0/Amt over $49
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Lenticular Lenses (in network / out of network)
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$0/Amt over $64
|
Frames (in network / out of network)
|
80% of Amt over $130 / Amt over $46
|
Contact Lenses (sample) (in network / out of network)*
|
Amt over $130 / Amt over $100
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Glasses (in network / out of network)
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20% off retail / no discount
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Frequency: Exams
|
Every Year
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Frequency: Lenses
|
Every Year
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Frequency: Frames
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Every 2 Years
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Dependent Age Limits (Non-Veteran/Veteran)
|
26/30**
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*This is intended only as a brief summary of benefits and is only a partial list of services. It is not an official statement of those benefits. Please See Plan Details Tab for more information.
**Coverage for unmarried dependents is extended to age 30 for Illinois residents with prior military service receiving an honorable discharge.