Plan Details
Plan Name Dental HMO
Description All Employees
Carrier Guardian
Effective Dates January 1, 2020 to January 1, 2021
Schedule of Benefits
General Plan Information
Annual Deductible/Individual $0
Annual Deductible/Family $0
Annual Plan Maximum N/A
Lifetime Orthodontia Plan Maximum
Diagnostic and Preventive Services
Diagnostic and Preventive 100%
Basic Services
Basic Various copays apply
Endodontic Treatment
Periodontic Treatment
Major Services
Major Various copays apply
Orthodontia Services
Orthodontia Various copays apply
Dependent Children
Adults (and Covered Full-Time Students, if Eligible)
Adult Lifetime Maximum