Guardian
Advantage Starter
- Large Network of Dentists
- Great for people who expect to need only cleanings and the occasional filling
- Graded Benefit Year Maximum
- Most Preventive Services Covered at 100%
| Common procedures: | |
|---|---|
| Cleaning: | 100% |
| White Filling: | 50% |
| Crown: | Not covered |
| Root Canals: | Not covered |
| Simple Extractions: | 50% |
| Plan Maximum: | $500 – 1st year $750 – 2nd year* $1000 – 3rd year* and after, per insured person * Plan Maximum increase every 12 months for 3 years, one preventive visit required per year per member to move to the next maximum level |
| Waiting Periods: | Preventive-None, Basic-6 months, Major-Not covered |
| Deductible: | $50 per person, deductible waived for Preventive Services in Network Only |
*Pennsylvania Residents: Basic Services waiting period is limited to 30-days. | |
| Details: |
|---|
| Fee Schedule: N/A | Dentist Search | Exams: |
| Routine periodic examinations – twice in a calendar year 100% – In Network 100% – Out of Network – after deductible Preventive – No waiting period | Cleanings: |
| Cleanings – twice in a calendar year 100% – In Network 100% – Out of Network – after deductible Preventive – No waiting period | X-Rays: |
| Radiography: Full mouth X-rays 100% – In Network 100% – Out of Network – after deductible Preventive – No waiting period | Fillings: |
| 50% – In Network – after deductible 50% – Out of Network – after deductible Basic – 6 months waiting period (In PA – 30-days) | Extractions: |
| Simple Extractions Only 50% – In Network – after deductible 50% – Out of Network – after deductible Basic – 6 months waiting period (In PA – 30-days) | Crowns: |
| Not Covered Service | Root Canals: |
| Not Covered Service | Dentures: |
| Not Covered Service | Deep Cleanings: |
| Not Covered Service | Implants: |
| Not Covered Service | Braces/Orthodontia: |
| Not Covered Service | Teeth Whitening: |
| Not Covered Service | Additional Network Information: |
The Advantage Starter gives you the freedom to receive dental treatment from any dentist You choose. This Plan usually pays a higher level of benefits for covered treatment furnished by a Contracted Dentist. Conversely, it usually pays less for covered treatment furnished by a Non-Contracted Dentist. Dentists who are contracted in Guardian’s network have agreed to accept a discount for the Covered Services they perform. When You visit one of these Dentists, the discount will lower Your out-of-pocket costs. *When You visit a Non-Contracted dentist, Your reimbursement will be based on Guardian’s fee schedule for Your specific Plan or on the 70th percentile of the prevailing fee data for the Dentist’s zip code. Exclusions and LimitationsPrivacy Policy Plan Brochure |
FAQ:
Can I change my dentist once I am in the plan?
Yes, you may change your dentist at any time.
What is a pre-existing condition versus work-in-progress? Is it covered?
A pre-existing condition is an oral health condition, which existed before your enrollment in a dental program. The plan does not include an exclusion for pre-existing conditions. However, expenses for the replacement of teeth that were lost or extracted prior to the policy effective date will not be covered.
Work in progress is any oral health procedure that is started and not completed prior to your enrollment in a dental program. The plan does not cover any expenses prior to the date you are covered under the Policy.
What provider options do I have?
The Advantage Dental Plans give you the freedom to receive dental treatment from any dentist You choose. This Plan usually pays a higher level of benefits for covered treatment furnished by a Contracted Dentist. Conversely, it usually pays less for covered treatment furnished by a Non-Contracted Dentist.
See “Additional Network Information” section above for more information.
When can I start using my Plan?
You can start using your plan once it goes into effect - usually the 1st of the month following your enrollment (as long as the enrollment and payment is received within the enrollment deadline). Incomplete enrollment forms or failure to submit the required initial premium amount may cause an initial delay in issuance of insurance. Do not cancel any other insurance or assume you are insured under the Plan until you receive your certificate of insurance.
When will I receive my new member kit and what will it include?
You will receive a Member ID card in the mail within 10 business days of your successful payment being processed. Please go online to "MyDental.GuardianLife.com" and register as a new member. Once you have registered you can print out state specific Plan information and the Plan benefit summary.
Who can enroll in this plan?
You and any of Your eligible dependents may enroll in this Plan. When You become eligible, You may enroll for dental insurance by completing the required enrollment application and sending the completed form to Us on a timely basis. In order for Your dependent coverage to start, You must also be covered under this Plan. You must enroll for a minimum of 12 months.
Eligible Dependents
Your eligible dependents are Your:
- Spouse; and
- Unmarried dependent child, including:
- A newborn child, natural child, stepchild or a child placed with You for adoption or foster care who is under age 30; and
- A child who is incapable of self-support because of a physical or mental incapacity. A dependent child may remain eligible for dependent benefits past the age limit, subject to the conditions below:
- The condition started before he or she reached the age limit; and
- The child remained continuously covered until he or she reached the age limit; and
- You send Us written proof, and We approve such proof, of the child’s disability and dependence within 31 days from the date he or she reaches the age limit. After the two-year period following the child’s attainment of the age limit, We can ask for periodic proof that the child’s condition continues, but We cannot ask for this proof more than once a year.
In order for Your dependent coverage to start, You must also be covered under this Plan.
If You initially waive dependent dental coverage under this Plan because Your dependent(s) were covered under another dental Plan, You can enroll Your dependent(s) under this Plan if his or her dental coverage will end due to one of the following Qualifying Events:
- Termination of Your Spouse's employment.
- Loss of eligibility under Your Spouse's dental Plan.
- Divorce.
- Death of Your Spouse.
- Termination of the other dental Plan.
- Any other event as required by state or federal law.
However, You must enroll Your dependent(s) under this Plan within 30 days of the Qualifying Event.
As long as you meet the plan’s general eligibility requirements and pay the applicable premium, your acceptance is automatic.
P.O. Box 981569
El Paso, TX 79998-1569
Disclaimers and Disclosures:
This website provides a very brief description of some of the important features of this plan. It is not the insurance contract, nor does it represent the insurance contract. A full description of benefits, exclusions and limitations is contained in the Schedule of Benefits and your policy.
Rates shown are based upon the information you provided, and are subject to change based on the dental and/or vision plan's underwriting practices and your selection of available optional benefits, if any. Final rates and effective dates are subject to underwriting and are always determined by the dental insurance and/or vision insurance company. To be considered for reimbursement, expenses must qualify as covered expenses.
This site was designed to provide you with a general description of the plans you requested. Keep in mind that it does not include all the benefits and limitations outlined in the policies -- it is the insurance contract, not the general descriptions on this website, which forms the contract between you and the insurance company.
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