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Family Dental Plan

PPO
Out of Network benefits are based on a usual and customary schedule.

Preventive Care

In Network
Guardian Pays
Out Of Network
Guardian Pays
Exams, cleaning, X-rays, topical fluoride
100%
90%

Restorative Services

In Network
Guardian Pays
Out Of Network
Guardian Pays
Fillings
Amalgam-One Surface; primary or permanent
80%
70%
Diagnostic Services
80%
70%

Major Services

After 6 month waiting period
In Network
Guardian Pays
Out Of Network
Guardian Pays
Crowns
50%
50%
Bridges
50%
50%
Dentures
50%
50%
The coinsurance/copayment amounts listed are examples and may be found on the Schedule of Benefits. This plan may not be available in all Counties. Please visit the See Plans and Prices section at www.healthcare.gov to confirm availability in your area.

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Don’t think that plan is the right fit for you? No worries! Take look at these:

DHMO

Family Dental HMO

  • A DHMO copay plan.

  • Includes Pediatric Essential Health Benefits

  • A comprehensive adult and child plan.

  • Covers standard or medically necessity orthodontic coverage.

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