Dental Plan

Supplemental Dental Plan

You will definitely have something to smile about when you enroll in our dental plan. Experience great benefits, national coverage and affordable rates:

• Coverage ranges from basic preventive care to crowns, bridges and orthodontia.
• Vast provider selection-over 120,000 dental PPO locations nationwide.
• No claim forms to file-PPO dentists do it for you!
• Benefits that increase the longer you are enrolled.
• Affordable rates and a rate category for people who need Self Plus One coverage.

Enroll online anytime or call 1-800-254-0227!

The charts below will give you an overview of these great dental benefits. And even more exciting, your benefits increase the longer you stay enrolled in the program!

Summary of PPO Dental Benefits

Topic	Calendar Year Deductible	First Year (1st-12th month of coverage)	Second Year (13th-24th month of coverage)	Third Year (25th month of coverage)
Preventive Care (twice annually) Exams, cleanings and bitewing x-rays	No deductible	100%	100%	100%
Basic Services Filings, extractions and other x-rays	$50 per person Up to $150 per family	70%	80%	80%
Major Services Root canals, crowns and bridges	$50 per person Up to $150 per family	Benefits begin in second year	50%	50%
Orthodontia Children 18 and under, $1,000 lifetime benefit maximum	$50 per person Up to $150 per family	Benefits begin in third year	Benefits begin in third year	50%

For dental coverage, annual deductible ($50 per person, $150 per family) applies to Basic and Major services. Annual benefit maximum for dental coverage: $1,000 per person, $3,000 per family. Coverage will not begin without payment of premium. After the first year, premiums are subject to change with 60 days notice.

Locate dental PPO providers near you. The Guardian Preferred Select Network is the PPO network for our dental plan.

View the rates for the MHBP Supplemental Dental Plan. To find your rate, locate the zip code of your home residence and select the desired coverage level.