2013 Employee Benefits Guidebook - Administration Home

Guardian
DENTAL PLANS
El Paso County offers two options with Guardian Dental: Low Option PPO and a High Option PPO. A
comparison of the two plans is shown on the following page.
On the Low and High Guardian Dental options, dental procedures are covered either through a Guardian
Dental Guard Preferred Network PPO dental provider or through any licensed dentist. A listing of Network
providers can be found through the Guardian website at www.GuardianAnytime.com, clock on the “Find a
Provider” in the right hand corner of the page. Next click the box “Find a Dentist”. When prompted for the
Dental Plan, select “PPO”, and for the Dental Network choose ‘DentalGuard Preferred” Network.
Guardian Dental
Comparison of 2013 Plans
DENTAL SERVICES LOW OPTION HIGH OPTION
In
Network
Out of
Network
In
Network
Out of
Network
Teeth Cleaning – 2 per calendar year 100% 80% 100% 100%
Oral Evaluations (Diagnostic) 100% 80% 100% 100%
X Rays (Diagnostic) 100% 80% 100% 100%
Lab and Other Diagnostic Tests 100% 80% 100% 100%
Prophylaxis (Preventive) 100% 80% 100% 100%
Fluoride Treatment (Preventive) for children
100% 80% 100% 100%
under age 19
Fillings (Amalgam & Anterior Composites) 80% 60% 90% 70%
Crowns: Stainless Steel 80% 60% 90% 70%
Simple Extractions 80% 60% 90% 70%
Oral Surgery (simple extractions) 80% 60% 90% 70%
Endodontic Services – Root Canal Therapy 50% 30% 90% 70%
Periodontal Services 50% 30% 90% 70%
Inlays/Onlays/Bridges 50% 30% 60% 30%
Dentures and other Removable Prosthetics 50% 30% 60% 30%
Fixed Prosthetics 50% 30% 60% 30%
Crowns: Resin, Metal 50% 30% 60% 30%
Implants 50% 30% 60% 30%
Orthodontia N/A N/A 50% 50%
Orthodontia Eligibility N/A Adults and Children
Deductible Per Person $50/$150 $50/$150 $25/$75 $50/$150
Deductible applies to Preventive & Diagnostic No No No No
Ortho Lifetime Maximum N/A N/A $1500
Calendar Maximum includes In and Out of
$1,000 $1,000 $1,500 $1,500
Network
Waiting Period applies No No
Out of Network Basis MAC UCR 90th
This Guidebook is only a summary of benefits and is not a binding contract. Summary Plan Documents, Certificates of Coverage, and the El Paso County
Policies and Procedures Manual describes benefits in great detail and are available through ESS or by contacting the Employee Benefits office. Should
there be differences between this summary and the plan documents, contracts or policies, the plan documents, contract, and/or policies will govern
Dental Rate Proposal
2013 Employee Benefit Guidebook
Updated August 2013