2023-2024 Benefits Guide

DENTAL PLAN

The EAA offers 2 dental insurance plans through Guardian Life. Both plans are PPO plans that can meet your needs; the difference is how out-of-network benefits are reimbursed. If you visit a dentist in the Guardian network, you will receive the most savings through either plan. To verify that your dentist is in network, visit the Guardian website. Make sure PPO is selected under Plan Type and search by location, dentist last name, or office name. If your dentist is in-network, you may consider enrolling in the Value Plan as the coinsurance amounts are higher resulting in increased coverage. If you currently have a dentist that is NOT in the Guardian network, and you do NOT want to change your dentist, you may consider enrolling in the NAP plan as it pays up 90% of the usual and customary rate within the service area for an out-of-network provider. Both plans have an individual deductible of $50. The types of services that you receive at the dentist’s office are categorized by type. The table below will show what percentage the plan covers after you meet your deductible based on the type of services you receive. IMPORTANT: After selecting a plan, you cannot change your selection until the next Open Enrollment period. PREVENTATIVE SERVICES include oral exams, cleanings, X-Rays, fluoride treatment, sealants. BASIC SERVICES include fillings, periodontal maintenance procedures, periodontal services, periodontal surgery, simple extractions, complex extractions, Endodontic Services, root canals. MAJOR SERVICES include bridges & dentures, implants, single crowns, repair and maintenance of crowns, general anesthesia, inlays, onlays, veneers, TMJ.

Guardian Dental Plans

PPO Value Plan

PPO Network Access Plan (NAP)

In-Network

Out-of-Network

In-Network

Out-of-Network

Deductible

$50

$50

Period

Calendar Year 3 per family Preventative

Calendar Year 3 per family Preventative

Family Limit Waived For

Annual Maximum Maximum Rollover Rollover Amount Account Limit Claim Payment Basis Threshold

$1500 plus Maximum Rollover

$1500 plus Maximum Rollover

$700 $350 $1,250

$700 $350 $1,250

Negotiated Fee Schedule

Negotiated Fee Schedule

Negotiated Fee Schedule

90

th % UCR

Coinsurance

Preventative

100% 100%

100% 100%

100%

100%

Basic Major

80% 50%

80% 50%

60%

60%

Orthodontia

50% for children (Orthodontia in Progress – covered)

50% for children (Orthodontia in Progress – covered)

Orthodontia Lifetime Maximum

$1500

$1500

Dependent Age Limits

To Age 26

To Age 26

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