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Dental

The dental plans offered by the Company are designed to assist you and your covered dependents by paying a portion of eligible expenses incurred for a wide range of dental services. The dental plans are administered by Guardian.

If you enroll within your initial eligibility period, your coverage will be effective on the first of the month following 30 days of employment.

If you do not enroll for coverage within your initial eligibility period, you may enroll for coverage during the next Annual Enrollment period or in accordance with the section entitled Making Changes During the Year.

Finding a Dentist

Click here to find a Dentist in your area and follow the steps below:

  1. Select Your Location: City, State Or Zip Code
  2. Select Your Dental Network: PPO or Managed Dental Care (DHMO)

Your Cost

The Company pays most of the cost of providing you and your eligible dependents with dental coverage. Your cost is generally deducted from your pay on a pretax basis. (Note: Coverage for domestic partners is generally deducted on an after-tax basis, unless otherwise permitted by state or federal law.) Refer to Employee Contributions for the applicable cost.

Dental Plan Key Features

The following table summarizes the key features of the plans available to you and your dependents. To receive the highest level of benefits, you should use in-network providers and fully understand what is expected of you.

Dental Plans (Guardian)
Key Features
Option 1
Option 2
Option 3
Option 4
PPO
Low Plan
PPO
Medium Plan
PPO
High Plan
Dental
DHMO Plan
In-Network
Out-of-Network**
In-Network
Out-of-Network**
In-Network
Out-of-Network**
In-Network Only
You Pay
You Pay
You Pay
You Pay
Annual Deductible (ded.)
Individual
$50
$50
$50
None
Family
$150
$150
$150
None
Plan Pays
Plan Pays
Plan Pays
Plan Pays
Annual Maximum Benefits (per person, excluding orthodontia)
$1,000
$1,250
$1,500 plus maximum rollover***
No maximum
Lifetime Orthodontia Maximum
Not covered
$1,000
$1,250
No maximum
Diagnostic and Preventive
Oral Exams (once/6 mos)
100%*
100%*
100%*
100%*
100%*
100%*
$5 office copay plus any copays applicable to specific procedures
Cleanings (once/6 mos)
100%*
100%*
100%*
100%*
100%*
100%*
Fluoride Treatments (once/6 mos, up to age 14)
100%*
100%*
100%*
100%*
100%*
100%*
Basic Services
X-rays; Fillings; Simple extractions; Sealants (to age 16, once/30mos); Space maintainers
80% after ded.
80% after ded.
80% after ded.
80% after ded.
90% after ded.
90% after ded.
$5 office copay plus any copays applicable to specific procedures
Major Restorative Services
Bridges & dentures; Endodontic services; Single crowns; Complex extractions; Crown, bridge & denture repair; General anesthesia; Perio maintenance (once/6mos); Combined cleanings/Perio maintenance (twice/12 mos); Periodontal surgery; Inlays, onlays & veneers
Not covered
Not covered
50% after ded.
50% after ded.
60% after ded.
60% after ded.
$5 office copay plus any copays applicable to specific procedures
Orthodontia
Not covered
Not covered
50%* (children only)
50%* (children only)
50%* (children and adults)
50%* (children and adults)
Varies by schedule
* Deductible waived.
** Out-of-Network claims are reimbursed at the MAC, as determined by Guardian. Using out-of-network providers may result in you being balance-billed by the provider
*** You may be eligible to rollover unused benefit dollars each year you are continuously enrolled under this plan. Refer to the plan document or call Guardian for more information.

This summary is provided for general information only. Refer to the specific plan documents available on the Forms and Downloads page for detailed information and complete plan provisions, exclusions and limitations.