Guardian Dental Insurance
Guardian is one of the largest insurance providers, selling insurance directly to corporate customers who provide their insurance to their employees as benefits. Founded in 1860, the company has become the fourth largest life insurance company, and provides other benefits to its customers and clients including vision, dental, and full health and through its financial services arm it offers life insurance, retirement and college savings planning. Let's get to the dental plans...
Most health insurance companies promote the use of dental insurance because proper dental care has been proven to reduce the risk of various diseases and promote overall health. Some of the most deadly, costly, and destructive diseases including heart attacks, diabetes, and even kidney disease has been attributed to improper dental care. With the cost of dental care tiny in comparison to other major medical, it's a near “no brainer” to promote regular dental hygiene and care.
Guardian offers two different plans, a Preferred Provider Organization (PPO) and a Dental Health Management Organization (DHMO). In a PPO, customers pay a small monthly fee to have access to Guardian's 70,000 dental providers at a discount of as much as 30% over regular prices. Through a DHMO, dental costs are paid directly by Guardian much like any other insurance, with prices first reduced to the PPO level. As you can expect, the PPO is less expensive, but requires higher out of pocket expenditures while the DHMO is more expensive out of pocket, but costs less at the time of use. Of course, if the plans are employer subsidized, the cost of premiums may be of little concern.
Sample Plan Structure
Guardian PPO members have access to the entire dental network at a 30% discount, and may have limited coverage for small and frequent treatments including cleanings and annual checkups.
DHMO's are more complex since they not only provide discounts on care, but also help subsidize the price. There are a few keywords that need to be understood to make sense of the benefits offered by Guardian Dental Insurance.
Calendar Year Deductible
A calendar year deductible is the amount of cash that has to be paid out of pocket for each individual. Usually $50 to $200, the calendar year deductible is drawn on each individual. Thus, for a three person family with a $200 individual deductible, a total of $600 would have to be paid out of pocket before benefits begin. However, if one family member uses $1000 of dental care, and others use only $100, then the total amount paid out of pocket before the insurance kicks in amounts to $400 total, $100 for two people, $200 for one person.
Calendar Year Maximum Benefit
The calendar year maximum benefit is the amount of money that can be claimed against a DHMO plan. The maximum benefit is designed to keep premiums lower since the insurance company is protected against extreme costs. Usually, maximum benefits range from $1,000 to $5,000 with rollovers equal to 25% of the total plan. So, if one were to use $1,000 of a $2,000 annual maximum, $500 could be rolled over to the next year, making the maximum benefit $2,500 the next year. The maximum benefit can be calculated on both individuals and families, depending on the plan.
Preventative medical is care that is designed to prevent from further, more costly or harmful problems. An annual cleaning and exam would be an example of preventative services because they reduce the risk of cavities and other dental problems in the future. Generally, preventative services are covered 100% with no co-payment or deductible in order to encourage routine care. Usually, preventative care and visits can be claimed only twice per year.
Basic services includes dental work over and beyond preventative care that is not normally assessed as part of a routine checkup. This includes fillings and basic tooth repair, but not major dental work. As a rule of thumb, basic services are covered up to a certain percentage by insurance and incur a co-payment and deductible.
Major dental includes large operations and surgeries, root canals, and reconstructive dental work. Major dental is usually covered to a smaller degree by insurance than basic services and incurs a deductible and co-payment.