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Preventive Plus for Families and Individuals

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

After 6 month waiting period
In Network
Guardian Pays
Out Of Network
Guardian Pays
Fillings
Amalgam-One Surface; primary or permanent
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

Essentials for Families and Individuals

  • 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$50

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$50

PPO

Select for Families and Individuals

  • 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

$800

Deductibles

FROM$50

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