Guardian Dental PPO

This is a brief description of common terms and conditions found in most Guardian Dental PPO plans.

In Westchester, Guardian Dental Insurance is one of the most popular dental plans. Many companies in and around Harrison, White Plains, Scasdale, and Rye, offer Guardian Dental to their employees.
Guardian offers a wide variety dental insurance plans, and the type of plan you have depends on the contract your employer signed with them. Many of the plans follow similar structure – but yours may have specific conditions and exclusions not found in any other.

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Annual Maximum Benefit –

Is what your insurance will pay in any given insurance year. For Guardian, it is typically between $1500 and $2500. Most Guardian Plans define INSURANCE YEAR from January 1 to December 31. Some plans, especially for school employees, may run on July 1-June 30 year. Check with your plan.

Annual Deductible –

what your insurance plan wants you to pay before they cover anything. For Guardian, it is usually $50.

Coverage for Preventive procedures –

what your insurance plan will pay for checkups, cleanings, X-rays, and sealants and fluoride for children. It is typically 100%, although some plans may pay less. Usually, the deductible does not apply.

Coverage for Cleanings and Checkups –

there are three types of frequencies allowed, twice a year, twice every 12 months, or once every 6 months. While they sound the same, they are actually very different.
Twice a year means twice every insurance year (typically January to December, but may be July to June, especially for school employees). Within that year, your insurance company will pay for 2 cleanings and checkups.
Twice every 12 months means your insurance company will pay for 2 cleanings and checkups every consecutive 12 months.
Once every 6 months means your insurance company will pay for one cleaning and checkup every 6 months to the day

Coverage for Basic procedures –

what your insurance plan will pay for fillings, root canals, gum treatments, and extractions. Most Guardian plans will cover 60-80% of the procedure costs. Sometimes, even though the plan says they will cover 80% of the procedure, their fees are so low that the actual coverage may be less.

Coverage for Major Procedures –

crowns, bridges, dentures. Typically, it is 50%, but it is subject to many provisions and restrictions, such as missing tooth clause, alternative minimum benefits, and others.

Coverage for Cosmetic Procedures –

veneers, teeth whitening, cosmetic bonding, adult orthodontics. No Guardian plan we have seen provides any coverage for these procedures.

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Coverage for Dental Implants –

varies greatly by the plan. Check with your carrier for specific information.