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Essentials for Families and Individuals

IDEM

Covered charges are the lesser of: (a) the Dentist’s actual changes; and (b) reasonable and customary charges for the dental services named in the Policy’s List of Covered Dental Services.
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Plan Summary Schedule of Benefits

Preventive Care

Guardian Pays
You Pay
Exams, cleaning, X-rays, topical fluoride
100%
0%

Restorative Services

6 month waiting period & deductible apply
Guardian Pays
You Pay
Fillings
Amalgam-One Surface; primary or permanent
50%
50%
Diagnostic Services
50%
50%

Major Services

12 month waiting period & deductible apply
Guardian Pays
You Pay
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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IDEM

Preventive Plus for Families and Individuals

Plan Summary Schedule of Benefits

  • Indemnity Plan for families that provides coverage for preventive and basic services.

  • Get most preventive services, such as oral exams, cleanings, and X-rays at 100% once the annual deductible has been reached.

Annual Maximum

$1000

Deductibles

FROM$50

View Details

IDEM

Basic for Families and Individuals

Plan Summary Schedule of Benefits

  • A family plan, including adults and children.

  • You are responsible for a percent of the total billed (coinsurance).

  • Get most preventive services, such as oral exams, cleanings, and X-rays at 100% once the annual deductible has been reached.

Annual Maximum

$1500

Deductibles

FROM$50

View Details

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