Educational services, including, but not limited to: (1) oral hygiene instruction; (2) tobacco counseling; or (3) nutritional counseling.

Any service, Appliance, Dental Prosthesis, modality or surgical service intended to treat or diagnose disturbances of the temporomandibular joint (TMJ) that are incidental to, or result from, a medical condition unless required due to state law. This includes, but is not limited to: (1) characterization and personalization of a Dental Prosthesis; (2) bleaching of discolored teeth; and (3) odontoplasty.

Pulp vitality tests or caries susceptibility tests. Maxillofacial prosthetics that repair or replace facial and skeletal anomalies, maxillofacial surgery, orthognathic surgery or any oral surgery requiring the settling of a fracture or dislocation that is incidental to or results form a medical condition. Treatment for which no charge is made.
,n-Network Dentist Guardian’s negotiated rates save you up to 35% at In-Network Dentists Out-of-Network Dentist Reimbursement is based on the lower of your dentist’s fees or the amount that would be paid to dentists who have agreed to be reimbursed according to Guardian’s negotiated fee schedule Your Plan Benefits Guardian Pays Any service or treatment method which does not meet professionally recognized standards of dental practice or which is considered to be experimental in nature. Any service furnished solely for cosmetic reasons. Educational services, including, but not limited to: (1) oral hygiene instruction; (2) tobacco counseling; or (3) nutritional counseling.

Any service or treatment method which does not meet professionally recognized standards of dental practice or which is considered to be experimental in nature. Those shown above are illustrative only. This policy provides DENTAL insurance only. Temporary or provisional Dental Prosthesis or Appliances except interim partial dentures (stayplates) to replace Anterior Teeth extracted while covered under this Policy. If We do raise Your premium due to a change in rates, then at least 60 days prior to Your renewal date, We will send written notice to You at Your last known address shown on record. A fixed bridge replacing the extracted portion of a hemisected tooth or the placement of more than one unit of a crown and/or bridge, per tooth. Products are not available in all states. Find an eye doctor Opens in an external window. If You are eligible for Medicare, review the Guide to Health Insurance for People with Medicare, which is available from the Company. Overdentures and related services including root canal therapy on teeth supporting an overdenture.

This usually means treatment furnished by: (1) the covered person’s employer, labor union or similar group, in its dental or medical department or clinic; (2) a facility owned or run by any governmental body; and (3) any public program, except Medicaid, paid for or sponsored by any governmental body.

Treatment needed due to: (1) an on-the-job or job-related injury; or (2) a condition for which benefits are payable by Worker’s Compensation or similar laws, only to the extent such benefits are the liability of the employee, employer, or Workers’ Compensation insurance carrier according to a final adjudication under the North Carolina Workers’ Compensation Act or an order of the North Carolina Industrial Commission approving a settlement agreement under the North Carolina Workers’ Compensation Act. Replacement of a lost, missing or stolen Appliance or Dental Prosthesis or the fabrication of a spare Appliance or Dental Prosthesis. Guardian’s negotiated rates save you up to 35% at In-Network Dentists, Reimbursement is based on the lower of your dentist’s fees or the amount that would be paid to dentists who have agreed to be reimbursed according to Guardian’s negotiated fee schedule, Most routine dental services, including oral exams, cleanings, x-rays, Moderately complex dental services, including fillings and simple extractions, More complex dental services including crowns, complex extractions, oral surgery, periodontal, and endodontic services, Benefit maximum payout increases every year for the 1st 3 years; one preventive visit required for each member each year.

If We do refuse, We must do so for a reason other than the deterioration of Your health on all Policies of this form issued under the same class in Your state. Dental Insurance is underwritten by The Guardian Life Insurance Company of America, New York, NY.

Charges for services provided by participating dentists are based on negotiated, discounted fee schedules, and are reimbursed directly from Guardian. Replacement of a lost, missing or stolen Appliance or Dental Prosthesis or the fabrication of a spare Appliance or Dental Prosthesis.

Duplication of radiograph images, the completion of claim forms.

Any restoration, service, Appliance or Dental Prosthesis used solely to: (1) alter vertical dimension; (2) restore or maintain occlusion; (3) treat a condition necessitated by attrition or abrasion; or (4) splint or stabilize teeth for periodontal reasons. Reimbursement is based on the lower of your dentist’s fees or the amount that would be paid to dentists who have agreed to be reimbursed according to Guardian’s negotiated fee schedule. But, We will cover cosmetic services needed to treat medically diagnosed congenital defects and birth abnormalities for a dependent child. Non-renewal will not affect any otherwise valid claim that starts while this Policy is in force.

Orthodontic treatment, unless the Policy provides specific benefits for orthodontic treatment.

Treatment for which no charge is made. Any service furnished solely for cosmetic reasons. The actual limitations and exclusions that apply to your Dental Plan are governed by the policy forms approved for use in your state. This usually means treatment furnished by: (1) the covered person's employer, labor union or similar group, in its dental or medical department or clinic; (2) a facility owned or run by any governmental body; and (3) any public program, except Medicaid, paid for or sponsored by any governmental body.. Guardian Dental Select Silver Coverage Summary (see your policy for further details) Choose any Dentist In-Network Dentist Guardian’s negotiated rates save you up to 35% at In-Network Dentists Out-of-Network Dentist Charges for services provided by participating dentists are based on Any service performed on a tooth or teeth with a guarded, questionable or poor prognosis. Any service, Appliance, Dental Prosthesis, modality or surgical service intended to treat or diagnose disturbances of the temporomandibular joint (TMJ) that are incidental to, or result from, a medical condition unless required due to state law.
Guardian Advantage PPO Silver.

The replacement of extracted or missing third molars (wisdom teeth).

This Policy is issued for a term of one year from the Policy Effective Date. This usually means treatment furnished by: (1) the covered person’s employer, labor union or similar group, in its dental or medical department or clinic; (2) a facility owned or run by any governmental body; and (3) any public program, except Medicaid, paid for or sponsored by any governmental body. Save up to 35% off standard dental rates with an in-network dentist Large Network of Dentists. This includes, but is not limited to: (1) characterization and personalization of a Dental Prosthesis; (2) bleaching of discolored teeth; and (3) odontoplasty. Treatment needed due to: (1) an on-the-job or job-related injury; or (2) a condition for which benefits are payable by Worker’s Compensation or similar laws. Products are not available in all states. Please refer to your plan documents for a complete list of limitations and exclusions.

Bite registration, bite analysis or occlusion analysis – mounted case. Treatment for which no charge is made. Find an eye doctor Opens in an external window. Application of desensitizing medicaments and desensitizing resins for cervical and/or root surface. Bite registration, bite analysis or occlusion analysis - mounted case.

THIS POLICY IS NOT A MEDICARE SUPPLEMENT POLICY.

• Get most services, including: oral exams, cleanings and x-rays covered at 80%. Tooth re-implantation or tooth transplantation. Guardian Dental Advantage Silver.

Any service performed on a tooth or teeth with a guarded, questionable or poor prognosis.

A fixed bridge replacing the extracted portion of a hemisected tooth or the placement of more than one unit of a crown and/or bridge, per tooth.

Any service furnished solely for cosmetic reasons. Duplication of radiograph images, the completion of claim forms, OSHA or other infection control charges. Any service performed in conjunction with, as part of, or related to a service which is not covered by this Policy.

Bite registration, bite analysis or occlusion analysis – mounted case. The localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue. Any restoration, service, Appliance or Dental Prosthesis used solely to: (1) alter vertical dimension; (2) restore or maintain occlusion; (3) treat a condition necessitated by attrition or abrasion; or (4) splint or stabilize teeth for periodontal reasons. A fixed bridge replacing the extracted portion of a hemisected tooth or the placement of more than one unit of a crown and/or bridge, per tooth. Products are not available in all states. Guardian Dental is underwritten by The Guardian Life Insurance Company of America, New York, NY. After one continuous year of coverage and acceptance of premium for any portion of the second or subsequent year sufficient notice shall be a number of full months most nearly equivalent to one fourth the number of months of continuous coverage from the inception date of the Policy, to the date of mailing of the notice. Those shown above are illustrative only.

Any service or treatment method which does not meet professionally recognized standards of dental practice or which is considered to be experimental in nature. Plan documents are the final arbiter of coverage. Policy limitations and exclusions apply. Pulp vitality tests or caries susceptibility tests.

The localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue.

If you choose to see a dentist outside of the Network, you'll be reimbursed based on Usual and Customary (UCR) charges. Overdentures and related services including root canal therapy on teeth supporting an overdenture. Temporary or provisional Dental Prosthesis or Appliances except interim partial dentures (stayplates) to replace Anterior Teeth extracted while covered under this Policy. Reimbursement is based on the lower of your dentist’s fees or the amount that would be paid to dentists who have agreed to be reimbursed according to Guardian’s negotiated fee schedule. Policy Form #IP-DEN-16 Policy limitations and exclusions apply. The localized delivery of antimicrobial agents via a controlled release vehicle into diseased crevicular tissue. Dental Insurance is underwritten by The Guardian Life Insurance Company of America, New York, NY. OSHA or other infection control charges. Guardian’s negotiated rates save you up to 35% at In-Network Dentists, Reimbursement is based on the lower of your dentist’s fees or the amount that would be paid to dentists who have agreed to be reimbursed according to Guardian’s negotiated fee schedule, Most routine dental services, including oral exams, cleanings, x-rays, Moderately complex dental services, including fillings and simple extractions, More complex dental services including crowns, complex extractions, oral surgery, periodontal, and endodontic services, Benefit maximum payout increases every year for the 1st 3 years; one preventive visit required for each member each year.

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