DENTAL INSURANCE
Leader's Casual Furniture offers dental coverage through Guardian. The Dental PPO Plans allow you to use in-network or out-of-network benefits. If out-of-network dentists are used, you will be responsible for paying the difference between Guardian’s allowed amount and what the dentist may charge, also known as “balance billing”. The charts below provides a brief overview of the plans.
DMO
PPO
Calendar Year Deductible
In-Network
Out-of-Network
Individual
$0
$25
$50
Family
$0
$75
$150
Annual Maximum
Unlimited
$1,500
$1,500
Diagnostic & Preventative
Exams
Fee Schedule
100%, no deductible
100%, no deductible
Cleanings
Fee Schedule
100%, no deductible
100%, no deductible
Fluoride
Fee Schedule
100%, no deductible
100%, no deductible
X-Rays
Fee Schedule
100%, no deductible
100%, no deductible
Sealants
Fee Schedule
100%, no deductible
100%, no deductible
Regular Restorative Services
*12 Month Waiting Period for late applicants
Amalgam Fillings
Fee Schedule
90%, after deductible
80%, after deductible
Extractions – Single Tooth
Fee Schedule
90%, after deductible
80%, after deductible
Endodontics (Root Canal)
Fee Schedule
90%, after deductible
80%, after deductible
Periodontics (Gum Disease)
Fee Schedule
90%, after deductible
80%, after deductible
Major Services
*No Waiting Period
*12 Month Waiting Period for late applicants
Crowns
Fee Schedule
60%, after deductible
50%, after deductible
Bridges
Fee Schedule
60%, after deductible
50%, after deductible
Dentures
Fee Schedule
60%, after deductible
50%, after deductible
Orthodontia
Child
Fee Schedule
50%, no deductible
Adult
Fee Schedule
50%, no deductible
Lifetime Max
N/A
$1,500
DHMO Employee Cost Per Pay Period
PPO Employee Cost Per Pay Period
Employee Only
$ 6.99
$17.22
Employee + Spouse
$13.99
$36.41
Employee + Child(ren)
$15.74
$38.74
Family
$25.33
$61.68
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