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NDNU Guardian Dental Plan Summary

Mananged DentalGuard
DHMO/Pre-Paid*
DentalGuard Pref/PPO**
In-Network
Out-of-Network
Calendar year Deductible
None

$50
3 per family limit

$50
3 per family limit
Preventive Care (e.g. cleanings)
Copay
100%
100%
of reasonable and customary charges
Basic Care (e.g. fillings, extractions)
Copay
90%
80%
of reasonable and customary charges
Major expenses (e.g. crowns, dentures)
Copay
60%
50%
of reasonable and customary charges
Orthodontia (Adult and Child)
50%
50%
50%
of reasonable and customary charges
Annual Maximum Benefit
Unlimited
$2,000
$1,500
Office Visit Copay
$0
None
Network
Managed DentalGuard
DentalGuard Pref
Monthly Switch
Yes
Yes

*You are only covered if you go to a dentist that belongs to the Managed DentalGuard – Pre-Paid (CA) network
** You may go to any dentist, however those who belong to the Dental - DentalGuard Pref - Northern California network will be most cost effective