The Guardian’s DentalGuard Program

What is Guardian’s DentalGuard Insurance?
An opportunity to help protect and care for your smile — and your family’s.

Can I visit any dentist or specialist or only certain ones?
If you go to a DentalGuard Preferred Network Provider, the benefits described on the Benefit and Cost Summary will be paid based on a reduced fee schedule (this will mean less out-of-pocket). The network provider cannot balance bill charges in excess of the fee schedule and you get more services with your yearly maximum. If you go to a non-contracted dentist, the benefits will be based on usual, customary and reasonable rates for a given area.

What is a plan deductible and/or annual maximum?
A deductible is the dollar amount of covered dental expenses you must pay during the year before benefits are paid by The Guardian. An annual maximum is the maximum amount your dental plan will pay in benefits during the year. Both are generally based on the calendar year. Deductibles and annual maximums apply to each covered person.

What is co-insurance?
For some services, you may share in the cost of your dental expenses. This is represented as a percentage of your dentist’s charges up to the usual, customary, and reasonable level. The percentage of co-insurance typically depends on the type of service received (Preventive or Basic).

What does usual, customary, and reasonable mean?
Usual, customary, and reasonable (UCR) charges for covered services are determined by using the usual level of charges made by the majority of dentists in the same geographic area for the same service. If your dentist’s fee is lower than the UCR charge, the plan will pay benefits based on the actual fee. If the fee is higher, the plan will pay benefits based only on the UCR charge, and you are responsible for any amount above the UCR limit.

What is pre-treatment review?
For all courses of treatment expected to exceed $300, your dentist should submit a report to The Guardian describing the proposed treatment and itemizing expected charges. We will review the report and send the dentist an estimate of benefits we will pay. This will help ensure that you receive the best and most appropriate care necessary. Emergency treatment, oral examinations, cleanings, and x-rays may be performed before the review is prepared.

When I visit a dentist, are there any claim forms to fill out?
Some dentists may submit claims directly to The Guardian. More often, however, dentists will require that you pay for services at the time they are rendered. Afterwards, complete a simple claim form and forward it to us along with a copy of your payment receipt.

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The Guardian Life Insurance Company of America, New York, NY
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