Dental Plan – MAPFRE Benefits

Dental Plan Overview

Dental Plans

MAPFRE offers two comprehensive dental plans through Guardian:

Low Plan
High Plan

Each option offers you access to Guardian’s extensive network of dental providers. When you receive services from in-network dentists, you’ll pay less out of your own pocket, because these dentists have agreed to discount their fees for plan participants. You can always choose a dentist outside the network, but you may be subject to higher out-of-pocket costs

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Guardian

Group # 552145

800-627-4200

www.guardiananytime.com

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Dental Benefit Summary

Benefits may be subject to certain restrictions and limitations.

LOW PLAN

BENEFITS – Guardian	LOW PLAN In-Network	LOW PLAN Out-of-Network
Annual Deductible
Individual	$50	$50
Dual	$100	$100
Family	$150	$150
Annual Maximums
Dental Annual Maximum	$750 per person	$750 per person
Orthodontia Lifetime Maximum	N/A	N/A
Type I – Preventive Services Reimbursement Level (X-rays, Cleanings 2x per year)	Plan pays 100%, deductible does not apply	Plan pays 100%, deductible does not apply
Type II – Basic Services (Fillings, Extractions, Root Canal)	Plan pays 80% after deductible	Plan pays 80% after deductible
Type III – Major Services (Crowns, Removable/Fixed Bridgework, Partial or Complete Dentures)	Plan pays 50% after deductible	Plan pays 50% after deductible
Type IV – Orthodontia	N/A	N/A
Network Website www.GuardianAnytime.com	DentalGuard Preferred	N/A

HIGH PLAN

BENEFITS – Guardian	HIGH PLAN In-Network	HIGH PLAN Out-of-Network
Annual Deductible
Individual	$50	$50
Dual	$100	$100
Family	$150	$150
Annual Maximums
Dental Annual Maximum	$1,500 per person	$1,500 per person
Orthodontia Lifetime Maximum	$1,500	$1,500
Type I – Preventive Services Reimbursement Level (X-rays, Cleanings 2x per year)	Plan pays 100%, deductible does not apply	Plan pays 100%, deductible does not apply
Type II – Basic Services (Fillings, Extractions, Root Canal)	Plan pays 80% after deductible	Plan pays 80% after deductible
Type III – Major Services (Crowns, Removable/Fixed Bridgework, Partial or Complete Dentures)	Plan pays 50% after deductible	Plan pays 50% after deductible
Type IV – Orthodontia	Plan pays 50%	Plan pays 50%
Network Website www.GuardianAnytime.com	DentalGuard Preferred	N/A

Maximum Rollover Benefit

The dental plan rollover benefit allows you to save dental funds for use in the future. If you do not reach your annual dental maximum, Guardian will roll over a portion of your unused dental maximum into an account, which can be used in future years if the plan’s annual maximum is reached.

IF you submit at least one claim in the calendar year

AND your total year claims don’t exceed:

$300 – Low Plan

$700 – High Plan

THEN, you can roll over to use next year and beyond:

$200* – Low Plan

$500* – High Plan

RESULTS: Your accumulated rollover total is capped at:

$500 – Low Plan

$1,250 – High Plan

*Amounts shown are applicable if all services are with in-network providers.

Dental Plan Resources

Use these resources to maximize your dental benefits.

Find a Network Dentist

To find an in-network dental provider in your area, visit Guardian’s website at www.guardiananytime.com or download Guardian’s Providers & ID Card app to your mobile device, and enter your plan type: PPO.

Setting Up Online Account

Pending

ID Cards

When you enroll in dental coverage, you will receive a Guardian ID card. However, you do not need an ID card to use your dental benefits. Simply provide your Group ID number 552145 to your provider at the first visit. If you’d also like to print a copy of your ID card, go to www.guardiananytime.com. After you register, you will find it under the “Forms and Materials” section.

Mobile App

With Guardian’s Providers & ID Card App, you can:

Find a network dentist
Access your ID card

The app is available through the Apple App Store and Google Play.

Dental Plan Overview

Dental Plans

Learn More

Dental Benefit Summary

Maximum Rollover Benefit

Dental Plan Resources

Eligibility and enrollment

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Financial Security

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