Guardian Dental Insurance Company - PowerPoint by xpf59682


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									  Santa Maria Bonita School District
Understanding How Your Benefits Work
       Educational Series 2008
         Dental Insurance
             Dental Insurance
• This is a self-funded plan. By self-funding the dental
  plan, SMB is able to reduce their plan costs by avoiding
  paying additional overhead/profit to the insurance
• Previously the dental plan was administered by ASI.
  Effective January 1st the new administrator was
• Guardian was chosen because they are able to deliver a
  much higher level of service and support and are much
  more capable of administering dental benefits for such a
  large group.
            Controlling Costs
• Because the dental plan is self-funded, SMB is
  able to hold down the cost of offering a very rich
  dental benefit plan at a minimal cost to the
• One of the keys to controlling the costs of the
  plan is to encourage use of Guardian network
  dentists. However, the plan still provides for a
  very rich out of network benefit if your dentist is
  not currently participating in the network.
        Guardian Dental Benefits
                              In Network         Out of Network
Preventive             100%                80%
Basic                  90%                 80%
Major                  60%                 50%
Orthodontia            50%                 0%
Calendar Year          $25                 $25
Annual Maximum Benefit $2,000              $2,000
Orthodontia Lifetime
Maximum Benefit        $2,000              n/a
               Network Dentists
• Finding a dentist is easy. Locate providers at or call their Dental Member
  Services Team at (800) 541-7846.
• Guardian is very actively growing their network of
  dentists in the area. It is in their best interest to have as
  many dentists contracted with them as possible.
• It is up to the dentist whether they want to accept
  Guardian’s contracted fees as payment in full. If they do
  not they will not accept Guardian’s coverage as a
  network provider but they will still accept payment from
 How To Nominate Your Dentist
• If you would like Guardian to approach your dentist to
  become contracted, you can fill out a Dentist Nomination
  form (available today or online at
• Dentist should only discuss their fee schedules (which
  are proprietary) with Guardian directly.
• Fee schedules are developed by Guardian to provide for
  less out of pocket expenses for the employees now and
  in the future.
  Information at your fingertips 24/7
Check out
to take a tour of the many available resources and great
information on the Guardian website for members.
    – Review benefits/ look up coverage amounts
    – Find a provider/ nominate a dentist not already accepting Guardian
    – View deductible and co-insurance amounts
    – Track progress toward your maximum out-of-pocket costs for the year
    – Check claim status
    – Print forms and plan materials
It’s Easy to Register!
    – Go to
    – Select the link for “Self-Register”
    – Follow the easy instructions
     Pre-Determination Review
• Guardian will gladly assist you and your dentist
  by determining what benefits could be payable
  for services and procedures over $300.
• Have your dentist fax Guardian your treatment
  plan with a note requesting a “pre-determination
  review” and Guardian will let your dentist know
  what benefits would be payable before you have
  the work done.
• This service is available for in and out of network
  claims including orthodontic treatment.
 Unclear about what your benefits
   are or still have questions?
• Call Guardian Dental Member Services
  at (800) 541-7846.
• Reference your personal Group Plan
  Number 432972 when calling Member
  Services and they will be able to provide
  you information specific to your plan

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