The Difference Between Option 1 (NAP Plan) and Option 2 (Value Plan) Is As Follows

The difference between Option 1 (NAP plan) and Option 2 (Value Plan) is as follows:

Option 2 (Value Plan) is a great plan if all of your dental providers are participating providers with the Guardian as preventive and basic services will be covered at 100% and any major services would be covered at 60%. Keep in mind that this applies to in network only. Under Option 1 (NAP Plan) preventive is covered at 100% but basic is covered at 80% and major at 50% - a bit less coverage than the value plan.

HOWEVER – if the employee’s dental providers do NOT participate with the Guardian then Option 1 (NAP Plan) is definitely the way to go as the out of network benefits are based on what is reasonable and customary for the area. Even though the percentages appear less under this plan – those percentages are based on what 90% of the dentists in that area charge for each service – so the payout is greater under this plan. Under Option 2 (Value Plan) the out of network benefits are based on the Guardian Fee Schedule only – so the Guardian will only pay out a specific percentage of their fee schedule. The downside to this is that if a provider happens to charge more than the Guardian allowed amount your employee could owe a lot more out of pocket. Under both plans the out of network provider has the right to balance bill the employee for any amounts over the 90th UCR and the Fee Schedule – but the financial responsibility would be less under Option 1 for Out Of Network providers.

If you are not sure if your provider is in network please visit: www.glic.com

From the Guardian homepage he can click on “Find A Provider” on the right hand side of the page and can follow the prompts from there.

The Dental plan you will want to select is PPO.

For the section of Select Your Dental Network please choose DentalGuard Preferred