CPC - 4.2026 Benefits Guide

DENTAL BENEFITS

MANAGED DENTAL GUARD PRE - PAID (NY) IN - NETWORK ONLY

HOW TO FIND A NETWORK DENTAL PROVIDER

BENEFIT

IN - NETWORK

It ’ s easy to find a dentist you can trust. Whether you ’ re looking for a list of providers that serve your plan (in - network) or trying to locate a specific dentist, it takes just minutes through Guardian ’ s Provider Online Search. Go to www.guardianlife.com . Click “ Find a Dentist ” . Under “ Plan Type ” select “ Managed Dental Care (DHMO/Prepaid) ” Enter your search criteria i.e. location, and/or providers name, then click on the search icon to see a list of providers. • • • •

Annual Deductible

None

Benefit Maximum Annual Lifetime

Unlimited 24 months of comprehensive Orthodontic treatment plus 24 months of retention

Office Visit

$5 copay

Diagnostic & Preventive Services Prophylaxis (Cleanings) Oral Examinations Topical Fluoride X - rays Bitewings

See fee for Service Schedule

Basic Services Fillings

See fee for Service Schedule

Endodontics Periodontics Space Maintainers

Major Services Surgical Removal of impacted teeth Dentures Crowns Inlays Onlays

See fee for Service Schedule

Orthodontic Services (adults and children)

See fee for Service Schedule

For additional information, please refer to your detailed plan summary. In the event of a discrepancy, the carrier Plan Document shall prevail.

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QUESTIONS? Call BenefitsVIP at 866.293.9736