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Dental

Dental

You have the option to select between two dental plans.

For More Information 
Call 1.800.541.7846 or visit www.guardianlife.com​​

PPO Plan

  • You will have the ability to seek care from providers inside or outside the Dental Guard Preferred network. 
  • Out-of-pocket costs are likely to be less when you choose an in-network dentist, as non-network providers can balance bill for their services
  • Coverage is available at 100% for Preventive and Basic Services, Major Services are covered at 60% and Orthodontia is covered at 50%
  • ​​Orthodontia is now covered for children and adults
  • There is no waiting period in between preventive care services. You have the ability to obtain 2 cleanings in a calendar year without the six month wait in between care
  In-Network Out-of-Network
Individual Deductible $25 $50
Family Deductible $75 $150
Deductible Waived for Preventitive Yes Yes
Annual Maximum Benefit $1,500 $1,500
Orthodontia Lifetime Maximum $1,500 $1,500
Type A: Preventive Care 100% 100%
Type B: Basic Care 100% 80%
Type C: Major Care 60% 50%
Orthodontia 50% 50%
Orthodontia Coverage Adult and Children Adult and Children

DHMO Plan  

  • For those seeking a lower per pay contribution 
  • You must seek care from a dentist in the DHMO network
  • Services within the plan have a set copay
  • There is no annual maximum on the number or types of services allowed
  • Services not covered when care received from an Out-of-network provider
  • Unavailable for employees in Columbus, Cincinnati, Toledo or Southern Ohio
  • ​​Orthodontia is now covered for children and adults
  • There is no waiting period in between preventive care services. You have the ability to obtain 2 cleanings in a calendar year without the six month wait in between care
Service In-Network
Clinical Oral Evaluation – Periodic oral evaluation $0
Clinical Oral Evaluation – Comprehensive oral evaluation $0
Prophylaxis – Adult/Child $0
Topical Fluoride – Topical application (w/o prophy) – child $0
Sealant Per Tooth Molars $8
Amalgam Restorations – one surface, primary/permanent $12
Amalgam Restorations – two surfaces, primary/permanent $14
Amalgam Restorations – three surfaces, primary/ permanent $17
Amalgam Restorations – four +surfaces, primary/permanent $375
Crowns – Porcelain fused to predominantly base metal $375
Crowns – Porcelain fused to noble metal $120
Root Canal Therapy – Anterior (excluding final restoration) $140
Root Canal Therapy – Bicuspid (excluding final restoration) $180
Root Canal Therapy – Molar (excluding final restoration) $240
Apicoectomy/Periradicular Surgery – Anterior $125
Gingivectomy – 4+ Teeth/Quad $50
Non-Surgical Periodontal – Scaling/root planing – four + $27
Non-Surgical Periodontal – Periodontal maintenance $452
Complete Dentures – Complete denture – upper $452
Complete Dentures – Complete denture – lower $500
Partial Dentures – Upper w/ metal base, resin saddles, etc. $12
Extraction, coronal remnants – deciduous tooth $15
Extractions – Erupted tooth or exposed root $40
Surgical Extractions – extraction of tooth; erupted $1,895 / $2,195
Orthodontia -Treatment (Child/Adult) Orthodontia -Treatment (Child/Adult)