This program helps you maximize your out-of-pocket savings by using network dentists, but also allows you to use any dentist you like and receive lower benefits. Following are many valuable benefits that can save you money:
With The Guardian’s PPO Program, you have options each time you need dental care. If you use an in-network dentist your out-of-pocket expenses will be lower. The Guardian has negotiated a fee schedule with in-network providers. You pay a percentage of an already discounted fee, which means lower costs.
Or, you can visit any out-of-network licensed dentist. The Guardian will pay a percentage of allowable (usual and customary) charges.
Physicians Only:
Association/Society members may apply as individuals to the Physician’s dental program only during special annual open enrollment periods.
In order to apply you must be:
Eligible dependents:
Physicians and Employees:
Groups of physicians and employees may apply for dental coverage at any time. However, if individuals in a group do not enroll when first eligible (within the first 60 days of employment), they are subject to a late entrant penalty. If enrolling after the first 60 days of employment, benefits are payable immediately for Preventive Services, for Basic Services after 6 months of coverage, and for Major Services after 12 months.
Employees of members may apply if:
This benefit allows an individual to rollover a portion of his or her unused annual maximum benefit each year as long as paid claims do not exceed a preset paid claims threshold. The rollover amount is deposited into a member’s MRA (maximum rollover account) for use with future dental expenses. The MRA may be used when a member exceeds the maximum annual plan benefit in any future year.
The maximum per person calendar year non-PPO benefit is $1,500 per person per calendar year ($2,000 under the PPO). As long as a covered individual does not exceed the annual $700 threshold in paid claims, he or she will have $350 accrued for future use in an MRA. If a member utilized only the services of a PPO provider during a year, then $500 will be added to the MRA. The maximum account balance is $1,250 per individual. When a covered individual exceeds the maximum annual plan benefit in any future year, additional benefits may be paid from the MRA.
The following participation requirements must be met:
| In-Network | Out-of-Network | |
| Maximum Benefit | $2,000 per person, per calendar year | $1,500 per person, per calendar year |
| Deductible, Calendar Year | $50 per person, $100 per family | $50 per person, $100 per family |
| Preventive Services Oral exams, X-rays, teeth cleaning, flouride treatments, topical sealants |
100% of negotiated fee schedule (deductible waived) | 80% of allowable charges (deductible waived) |
| Basic Services Lab tests, amalgam, silicate or acrylic fillings, root canal, oral surgery, anethesia, stainless steel & acrylic crowns |
80% of negotiated fee schedule | 70% of allowable charges |
| Major Services Gold & porcelain fillings & crowns, prosthetics — subject to waiting period of 12 months |
50% of negotiated fee schedule | 40% of allowable charges |
| Endodontics/Periodontics | 80% of negotiated fee schedule | 70% of allowable charges |
| Orthodontia Subject to waiting period of 12 months |
50% of negotiated fee schedule —$500 per calendar year maximum |
40% of allowable charges—$500 per calendar year maximum |
| Maximum Annual Benefit per Person |
Paid Claims Threshold Amount |
Maximum Rollover Amount | In-Network Only Services Maximum Rollover Amount |
Maximum Rollover Account (MRA) Limit |
$1,500 per person per cal yr. |
$700 |
$350 |
$500 |
$1,250 |
Here is an example of how this new benefit can work for an individual:
| Year | Annual Paid Claims for an Individual |
PPO Providers Only? | Paid Claims Greater than $700 |
Result | Balance in MRA |
1 |
$400 |
No |
No |
$350 credited to MRA |
$350 |
2 |
$900 |
No |
Yes |
$0 credited to MRA |
$350 |
3 |
$600 |
Yes |
No |
$500 credited to MRA |
$850 |
4 |
$2,100* |
No |
Yes |
$0 credited to MRA; $600 withdrawn |
$250 |
| *Assumes all services provided by out-of-network dentists | |||||
Your coverage will terminate:
Dependent coverage will terminate when:
Employee coverage will terminate:
The plan does not pay for:
Click on the "Download Now" button for an Enrollment Form and brochure, complete and return to us. Send No Money Now. You will be billed for your payment upon approval of your application by The Guardian.
A Client Advisor is available to answer your questions. Please call AMBA at 1-800-842-3761.
The information on this Web site is intended to outline the principal features of the group insurance program. All statements are subject to the terms of the contract between the Planholder and The Guardian Life Insurance Company of America. Additional details on covered expenses and exclusions are to be found in the certificate booklet given to each insured individual.
Administered by: AMBA Administrators, Inc.
The Guardian Life Insurance Company of America
7 Hanover Square, New York, NY 10004
Important Information about Guardian's DentalGuard Preferred PPO Plans: This policy provides dental insurance only. 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. The plan does 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. The plan limits benefits for diagnostic consultations and for preventive, restorative, endodontic, periodontic and prosthodontic services. The services, exclusions, and limitations listed above do not constitute a contract and are a summary only. The Guardian plan documents are the final arbiter of coverage. GP-1-DG2000, et al.
Association Member Benefits Advisors
4050 NW 114th Street, Urbandale, IA 50322
[email protected]
CA Insurance License #0I96562
1-800-842-3761
We're here to help! Please contact us in whatever manner is most convenient for you.
| Address Association Member Benefits Advisors 4050 NW 114th Street Urbandale, Iowa 50322 |
|---|
| Phone 1-800-842-3761 |
| Hours M-F 8a-5p PST |
| Fax 213-346-5946 |
| Email [email protected] |