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The maximum payment your dental plan will make within a given time period. Some plans have no maximum. Some maximums apply to the lifetime of the benefit plan; others apply to a particular time period (calendar year, benefit year, etc.) or to particular services (such as a separate maximum for orthodontic benefits).

The total amount (usually expressed as an annual figure) enrollees must pay toward treatment before their health benefits are paid. The deductible plus the copayment and amount over the annual maximum are often referred to as the enrollee’s out-of-pocket costs. Under Delta Dental benefit plans, diagnostic and preventive services are often exempt from a deductible.

The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.

Services related to misaligned teeth and/or jaws.

A request for verification of benefits before rendering services.

The remaining payment your your dental plan will make within a given time period.

The remaining amount you have to pay in order to reach your maximum out of pocket expense for covered services.

Basic services (fillings) and diagnostic services.

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Find a Guardian dental insurance plan in your state. We offer plans directly or through the healthcare marketplace that fit your budget and coverage needs.

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2025 DHMO Illinois ManagedCare for Families and Individuals

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Forms & Documents

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Provider Nomination Form

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