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 company. • Previously the dental plan was administered by ASI. Effective January 1st the new administrator was Guardian. • 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 employee. • 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 Deductible 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 www.guardianlife.com 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 Guardian. 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 www.guardianlife.com) • 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 www.GuardianAnytime.net/webtour/member 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 insurance – 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 www.GuardianAnytime.com – 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 benefits.
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