2018 Bridging Freedom Benefits at a Glance

DENTAL INSURANCE

Bridging Freedom offers dental coverage through a Guardian PPO plan. The plan allows you to use in-network or out-of-network benefits. If out-of-network dentists are used, you will be responsible to pay 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 plan.

Dental PPO Plan

In-Network

Out-of-Network

Deductible

Individual

$50

$150

Family

$150

$300

Annual Maximum

Per covered person

$1,000

$1,000

Preventative Care

Covered at 100%

Covered at 80% after deductible

Basic Procedures

Covered at 80% after deductible Covered at 70% after deductible

Major Procedures

Includes Endo and Perio services

Covered at 50% after deductible Covered at 40% after deductible

Orthodontia (Child Only)

50% Lifetime Max $1,000

Waiting Periods

Orthodontia: 12 months

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