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Pediatric Essentials

PPO
Out of Network benefits are based on a covered fee schedule.

Preventive Care

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

Restorative Services

In Network
Guardian Pays
Out Of Network
Guardian Pays
Fillings
Amalgam-One Surface; primary or permanent
50%
50%
Diagnostic Services
50%
50%

Major Services

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:

PPO

Basics for Families and Individuals

  • 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$60

PPO

Family Essentials

  • A comprehensive 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

$1000

Deductibles

FROM$60

PPO

Preventive Plus for Families and Individuals

  • A PPO 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$60

DHMO

Managed DentalGuard Child Essentials

  • A DHMO copay plan.

  • Pediatric Essential Health Benefits

  • A comprehensive child plan.

  • Covers medically necessity orthodontic coverage.

DHMO

Managed DentalGuard Family Plan

  • 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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