Dental Plan Benefits

Gdn Dental Coverage Grid 092025
Gdn Dental Coverage Grid_2 092025

Disclosures and General Exclusions

Exclusions and Limitations

Important Information about Guardian’s DentalGuard Indemnity and DentalGuard Preferred Network PPO plans: 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 (unless they are  expressly provided for), any treatments to  the extent benefits are payable by any  other payor or for which no charge is made, prosthetic devices unless certain  conditions are 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. 

PPO and or Indemnity 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.

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.   The Plan Summary can be found here.