Guardian - Guardian Essentials for Families and Individuals
Benefits Resources |
|---|
| Provider Directory |
| Summary of Benefits and Coverage |
| Download Plan Brochure |
Summary |
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|---|---|
| Plan Name | Guardian Essentials for Families and Individuals |
| Plan Type | PPO |
| Plan Tier | LOW |
Deductible & Out-of-Pocket Max |
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|---|---|
| Dental Deductible (Family) | Not Applicable |
| Dental Deductible (Individual) |
$60 (In Network) $120 (Out-of-Network) |
| Child Dental Out-Of-Pocket Maximum (Family) |
$750 (In Network) |
| Child Dental Out-Of-Pocket Maximum (Individual) |
$375 (In Network) |
Routine Dental Services (Adult)
In Network
No Charge after deductible
Out-of-Network
No Charge after deductible
Dental Check Up (Child)
In Network
No Charge after deductible
Out-of-Network
No Charge after deductible
Basic Dental Care (Child)
In Network
50% Coinsurance after deductible
Out-of-Network
50% Coinsurance after deductible
Orthodontia(Child)
In Network
50% Coinsurance
Out-of-Network
100% Coinsurance
Major Dental Care (Child)
In Network
50% Coinsurance after deductible
Out-of-Network
50% Coinsurance after deductible
Basic Dental Care (Adult)
In Network
50% Coinsurance after deductible
Out-of-Network
50% Coinsurance after deductible
Orthodontia(Adult)
In Network
Not covered
Out-of-Network
Not covered
Major Dental Care (Adult)
In Network
50% Coinsurance after deductible
Out-of-Network
50% Coinsurance after deductible
Accidental Dental
In Network
Not covered
Out-of-Network
Not covered