DENTAL PROGRAM
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Maximum Benefit
The benefit that will be paid by the AFTRA Health Fund under the Dental Program for Preventive Services is limited to $1,000 for treatment of any one individual in any calendar year.
This maximum applies whether you use a Participating Dentist, Non‑Participating Dentist or a combination of both.
Dental Fee Limits
A Participating Dentist is one who has agreed to be part of Guardian's DentalGuard Preferred provider network and accept as full payment a discounted fee for covered dental services. Your benefits paid under the Plan will be based on these discounted fees, if you use a Participating Dentist.
A Non‑Participating Dentist is one who is not a member of Guardian's DentaIGuard Preferred provider network. When using a Non-Participating Dentist the maximum fee taken into account in computing the benefit you will receive is based on a schedule of the 85th percentile of prevailing charges. This means that your benefit will be based on no more than the highest fee that 85% of dentists in a geographic area charge for a given service.
Whether you use a combination of Participating and Non‑Participating Dentists, there is no deductible required.
The Fund will pay 100% of the Participating Dentist’s fee. If a Non-Participating Dentist provides the services, the Fund will pay 75% of the fee up to an amount equal to the 85th percentile of prevailing charges for the service in your dentist's geographic area.
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< PREVIOUS TABLE OF CONTENTS NEXT >
Maximum Benefit
The benefit that will be paid by the AFTRA Health Fund under the Dental Program for Preventive Services is limited to $1,000 for treatment of any one individual in any calendar year.
This maximum applies whether you use a Participating Dentist, Non‑Participating Dentist or a combination of both.
Dental Fee Limits
A Participating Dentist is one who has agreed to be part of Guardian's DentalGuard Preferred provider network and accept as full payment a discounted fee for covered dental services. Your benefits paid under the Plan will be based on these discounted fees, if you use a Participating Dentist.
A Non‑Participating Dentist is one who is not a member of Guardian's DentaIGuard Preferred provider network. When using a Non-Participating Dentist the maximum fee taken into account in computing the benefit you will receive is based on a schedule of the 85th percentile of prevailing charges. This means that your benefit will be based on no more than the highest fee that 85% of dentists in a geographic area charge for a given service.
Whether you use a combination of Participating and Non‑Participating Dentists, there is no deductible required.
The Fund will pay 100% of the Participating Dentist’s fee. If a Non-Participating Dentist provides the services, the Fund will pay 75% of the fee up to an amount equal to the 85th percentile of prevailing charges for the service in your dentist's geographic area.
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