Medical/Dental Residents
Affiliated with Graduate Medical / Dental Education Consortium of Buffalo

Find A Dentist

The Graduate Medical/Dental Education Consortium of Buffalo is pleased to announce that effective 02/01/03
The Dental Plans will be provided by The Guardian.

All residents currently enrolled in the current Dental Plan
will not be required to complete any additional applications.

DENTAL INSURANCE

All coverages and deductibles remain the same.

Benefit and Cost Summary
for Dental has been prepared for the employees of:

University Medical/Dental Resident Services, P.C.
Deductible- $50 individual

Percentage Paid
Preventive Services - 100%

Services
Emergency Palliative Treatment
Oral Examination - every six months
X-Rays - four bitewings every twelve months full mouth series every five years
Teeth Cleaning - every six months
Fluoride Treatments for Children - every six months under age 14
Space Maintainers for Children - under age 16
Topical Sealants for unrestored molar teeth
-one treatment for child(ren) under 16 in a three (3) year period

Basic Services 80%

Laboratory Test
Diagnostic Consultation- one per year
Fillings: Amalgam, Silicate & Acrylic
Crowns: Stainless Steel
Repairs of dentures, bridgework, crowns, etc.
Endodontic Services/Root Canal Therapy
Periodontal Services
Oral Surgery- Uncomplicated extractions
General Anesthesia- surgical procedures only
Injectable Antibiotics- for treatment of a dental condition only

• There is an $1,000 annual maximum for all coverages combined.
• Deductible is waived for Preventive services. 3 individual deductibles per family.
• Children are covered up to age 20 or 26 if a full time student.
• There are no waiting periods for any services (unless Employee/Dependents are a Late Entrant 1 ).
• All out of network services are based on usual, reasonable, and customary rates for given area.
• Access to a network access plan - a listing of dentists contracted with Guardian to provide additional discounts off services and procedures to Guardian dental plan members. Locate these dentists on the web at www.glic.com.
• Dental Claims - P. O. Box 2459, Spokane, WA 99210-2459, ph: 1-800-541-7846, fax: 509-468-4590.
• Pre-determination Review - Guardian will gladly assist you and your dentist by determining what benefits could be payable for services and procedures over $300. Have your dentist fax your treatment plan to Guardian, note that it is a pre-determination review and we will let your dentist know what benefits would be
  payable.

  •Special Limitation: Teeth lost or missing before a covered person becomes insured by this plan. A covered
  person may have one or more congenitally missing teeth or have lost one or more teeth before he became
  insured by this plan. We won’t pay for a prosthetic device which replaces such teeth unless the device also
  replaces one or more natural teeth lost or extracted after the covered person became insured by this plan.
  R3 - DG2000
  1 A late entrant is a person who becomes insured more than 31 days after he is eligible; or becomes insured again, after his
  coverage lapsed because he did not make required payments. We won’t cover charges incurred by a late entrant for (1)
  Group II (basic) services until 6 months from the date he is insured by this plan.

  DentalGuard General Limitations and Exclusions: 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. 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 treatments 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. Contract # GP-1-DNTL-90-1 et al.

More Questions and Answers

Application
Used for changes only (Add/Delete - Spouse/Child, Addresses, etc.)

Find A Dentist

Dental Claim Form

This handout is for illustrative purposes. You will receive benefit booklets. If there is a
discrepancy between this handout and your benefit booklet, the benefit booklet prevails.

Any questions regarding the Group Long Term Disability or Dental Insurance Plans should be directed to MJB Financial Services, Inc., Michael J. Bruno, Plan Administrator at (716) 877-7079. Mike can also be reached via email at Michael@mjbfinancial.com.