The Guardian network is a PPO Plan which allows each participant the opportunity to use their dental and vision benefits in or out of network.  You can choose the dentist or vision professional that you prefer!

SimpleHR offers two different options for Guardian Dental Plans and a competitive Vision Plan as well. They are as follows:


To find out more about our Dental and Vision insurance broker, click here.

 

Guardian Dental Plan Details

SimpleHR High Option
In-Network Deductible - $50 (*Waived for Preventive Services)
Out-of-Network Deductible - $100 (*Waived for Preventive Services)
     
  Services
Percentage Paid
 
In Network
Out of Network
  Preventive Services*
100%
100%
       
  Emergency Palliative Treatment
   
  Oral Examination - every six months    
  X-Rays - four bitewings every twelve months full mouth series every 5 years
   
  Teeth Cleaning - every six months    
  Fluoride Treatment for Children - every six months under age 14
   
  Space Maintainers for Children - under age 16
   
  Topical Sealants for unrestored molar teeth    
  -one treatment for child(ren) under 16 in a three (3) year period    
       
  Basic Services
80%
80%
       
  Laboratory Test    
  Diagnostic Consultation- one per year    
  Fillings: Amalgam, Acrylic, & Posterior Composite    
  Crowns: Stainless Steel    
  Repairs of dentures, bridgework, crowns, etc.
   
  General Anesthesia- surgical procedures only
   
  Injectable Antibiotics- for treatment of a dental condition only
   
       
  Major Services
50%
50%
       
  Bridges Installation-fixed and removable    
  Dentures- Full and Partial    
  Crowns: Acrylic Metal, Porcelain
   
  Inlays
   
  Onlays
   
  Posts
   
  Implants    
  Oral Surgery- Uncomplicated extractions    
  Endodontic Services/Root Canal Therapy    
  Periodontal Services    
       
  Orthodontic Services
50%
50%
 

 

   
 

$1,500 Lifetime Maximum for child(ren) under age 19
The deductible does not apply to Orthodontic services.

   
       
  There is a $2,000 in-network and $1,000 out-of-network annual maximum for Preventive, Basic, and Major services combined, subject to the maximum rollover.
  Maximum Rollover: With Maximum Rollover, we'll roll over a portion of each member's unused annual maximum, called the Maximum Rollover Amount, into his or her Maximum Rollover Account (MRA). The MRA can be used in future years, if a member reaches the plan's Annual Maximum.
  Even better, if a member uses the services of Preferred Providers exclusively during the benefit year, we'll increase the amount credited to his or her MRA to the In-network Only Maximum Rollover Amount.
  To qualify, a member must submit a claim and not exceed the paid claims threshold during the benefit year. The employee and each insured dependent maintain separate MRAs based on their own claim activity. Each member's MRA may not exceed the MRA limit.
       
 
    Plan Annual Maximum*
Threshold
Maximum Rollover Amount
In-Network Only Maximum Rollover Amount
Maximum Rollover Account Limit
$1000
$500
$250
$350
$1000
  *If a plan has a different annual maximum for PPO benefits vs. non-PPO benefits, ($1500 PPO/$1000 non PPO for example) the non-PPO maximum determines the Maximum Rollover plan.
       
  Deductible is waived for Preventive services. 3 individual deductibles per family.
  Eligible dependants include your unmarried children up to age 20 or 26, if the child is dependant upon the employee for support and is: (i) living in the employee's household; or (ii) a full-time or part-time student.
  Employee/Dependents enrolling outside of the plan eligibility period may be subject to Late Entrant** penalties
  All out of network services are based on usual, responsible, and customary rates for a given area
  Dental Claims- P.O. 2459, Spokane, WA 99210-2459, ph:1-800-541-7846, fax:509-468-4590.
  Guardian has contracted with dental providers to provide discounts off services and procedures to Guardian dental plan members. To locate a provider, please reference our On-Line Provider Directory at  www.GuardianLife.com
  Pre-Determination Review - Guardian will gladly assist you and your dentist by determining what benefits could be payable for services and procedures over $300. Have your dentist fax your treatment plan to Guardian, note that it is a pre-determination review and we will let your dentist know what benefits would be payable. (This includes orthodontic treatment if your plan includes it)
  Special Limitation: Teeth lost or missing before a covered person becomes insured by this plan. A covered person may have one or more congenitally missing teeth or have lost one or more teeth before he became insured by this plan. We won't pay for a prosthetic device which replaces such teeth unless the device also replaces one or more natural teeth lost or extracted after the covered person became insured by this plan. R3-DG2000
   
  **A late entrant is a person who becomes insured more than 31 days after he is eligible; or becomes insured again, after his coverage lapsed because he did not make required payments. We won't cover charges incurred by a late entrant for (1) Group 2 (basic) services until 6 months from the date he is insured by this plan; and (2) Group 3 (major) services until 12 months from the date he is insured by this plan and (3) Group 4 (orthodontics) services until 24 months from the date he is insured by this plan
   
  DentalGuard General Limitations and Exclusions: This policy provides dental insurance only. Coverage is limited to those charges that are necessary to prevent, diagnose or treat dental disease, defect, or injury. Deductibles apply. The plan does not pay for: oral hygiene services (except as covered under preventive services), orthodontia (unless expressly provided for), cosmetic or experimental treatments, any treatments to the extent benefits are payable by any payor or for which no charge is made, prosthetic devices unless certain conditions are not met, and services ancillary to surgical treatment. The plan limits benefits for diagnostic consultations and for preventive, restorative, endodontic, periodontic, and prosthodontic services. The services, exclusions and limitations listed above do not constitute a contract and are a summary only. The Guardian plan documents are the final arbiter of coverage. Contract # GP-1-DG2000 et al.
   

Guardian Dental Plan Details

SimpleHR Low Option
In-Network Deductible - $50 (*Waived for Preventive Services)
Out-of-Network Deductible - $100 (*Waived for Preventive Services)
     
  Services
Percentage Paid
   
In Network
Out of Network
 
  Preventive Services*
80%
80%
   
  Emergency Palliative Treatment
  Oral Examination - every six months
  X-Rays - four bitewings every twelve months full mouth series every 5 years
  Teeth Cleaning - every six months
  Fluoride Treatment for Children - every six months under age 14
  Space Maintainers for Children - under age 16
  Topical Sealants for unrestored molar teeth
  -one treatment for child(ren) under 16 in a three (3) year period
   
  Basic Services
70%
70%
       
  Laboratory Test    
  Diagnostic Consultation- one per year    
  Fillings: Amalgam, Acrylic, & Posterior Composite    
  Crowns: Stainless Steel    
  Repairs of dentures, bridgework, crowns, etc.
   
  Endodontic Services/Root Canal Therapy    
  Periodontal Services    
  General Anesthesia- surgical procedures only
   
  Injectable Antibiotics- for treatment of a dental condition only
   
       
  There is a $1,000 annual maximum for Preventive, Basic and Major services combined
  Deductible is waived for Preventative Services
  3 individual deductibles per family
  Eligible dependants include your unmarried children up to age 20 or 26, if the child is dependant upon the employee for support and is (i) living in the employee's household; or (ii) a full-time or part-time student
  Employee/Dependents enrolling outside of the plan eligibility period may be subject to Late Entrant** penalties.
  All out-of-network services are based on usual, responsible, and customary rates for given area.
  Guardian has contracted with dental providers to provide discounts off services and procedures to Guardian dental plan members. To locate a provider, please reference our On-Line Provider Directory at www.GuardianLife.com
  Dental Claims - P.O. Box 2459, Spokane, WA 99210-2459, ph: 1-800-541-7846, fax: 509-468-4590.
  Pre-Determination Review - Guardian will gladly assist you and your dentist by determining what benefits could be payable for services and procedures over $300. Have your dentist fax your treatment plan to Guardian, note that it is a pre-determination review and we will let your dentist know what benefits would be payable.
   
  **A late entrant is a person who becomes insured more than 31 days after he is eligible; or becomes insured again, after his coverage lapsed because he did not make required payments. We won't cover charges incurred by a late entrant for Group 2 (basic) services until 6 months from the date he is insured by this plan
   
 

DentalGuard General Limitations and Exclusions: This policy provides dental insurance only. Coverage is limited to those charges that are necessary to prevent, diagnose or treat dental disease, defect, or injury. Deductibles apply. The plan does not pay for: oral hygiene services (except as covered under preventive services), orthodontia (unless expressly provided for), cosmetic or experimental treatments, any treatments to the extent benefits are payable by any payor or for which no charge is made, prosthetic devices unless certain conditions are not met, and services ancillary to surgical treatment. The plan limits benefits for diagnostic consultations and for preventive, restorative, endodontic, periodontic, and prosthodontic services. The services, exclusions and limitations listed above do not constitute a contract and are a summary only. The Guardian plan documents are the final arbiter of coverage. Contract # GP-1-DG2000 et al.

 

Guardian Vision Plan Details

 

 
Benefit Details
 
In Network
Out of Network
Eye Exams    
Frequency: Every 12 Months
$10.00 Copay
$46.00 Maximum after Copay
     
Lenses    
Frequency: Every 12 Months    
Single Vision
$25.00 Copay
$47.00 Maximum after Copay
Bifocal
$25.00 Copay
$66.00 Maximum after Copay
Trifocal
$25.00 Copay
$85.00 Maximum after Copay
Lenticular
$25.00 Copay
$125.00 Maximum after Copay
     
Contact Lenses    
Frequency: Every 12 Months    
Medically Necessary
$25.00 Copay
$210.00 Maximum after Copay
Elective
$120.00 Maximum (Copay Does Not Apply)
     
Frames    
Frequency: Every 24 Months
$120.00 Retail Allowance** $47.00 Maximum after Copay
   
*If you choose contact lenses, you will not be eligible to receive lenses for 12 months and a frame for 24 months following the date contacts were obtained.
   
**Approximately 15,000 frames are covered in full. Frames not fully covered are offered at a discounted cost. If you select a frame that exceeds the retail allowance, the plan will cover 20% of the amount above the allowance. You must pay the rest.
   
Note: Lens coverage includes polycarbonate lenses for children up to the plan's non-student dependent child age limits 19 (26 full-time student).

 


Broker Information


Our Health Insurance broker can be reached at the following:

 

David Barton

Barton, Fenstermaker, Tondello & Associates

28 NE Walter Martin Road

Suite B

Fort Walton Beach, FL 32548

 

Office: 850-243-2602

Fax: 850-243-4299