Plan documents are the final arbiter of coverage. Dental Accident Critical Illness Pets Best
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1 Benefit Disclosures Accident, Critical Illness or Dental individual coverage may not be available in all states. These individual policies have exclusions and limitations and provisions regarding termination of coverage. Rates will vary by plan design. Plan documents are the final arbiter of coverage. Dental Accident Critical Illness Pets Best GUARDIAN, the GUARDIAN G logo and Guardian Direct TM are registered service marks and registered trademarks of The Guardian Life Insurance Company of America and are used with express permission. Guardian products are those identified as having been issued or underwritten by The Guardian Life Insurance Company of America (Guardian) or a named Guardian owned subsidiary. Products or services advertised or offered by non-guardian companies on Guardian s website(s) are subject to each company s participation requirements which Guardian does not control. The Guardian Life Insurance Company of America is domiciled in the state of New York.
2 Dental Individual dental insurance products are underwritten by The Guardian Life Insurance Company of America, New York, New York or by one of its wholly owned subsidiaries. Products are not available in all states. Policy limitations and exclusions apply. The actual limitations and exclusions that apply to your Dental Plan are governed by the policy forms approved for use in your state. Please refer to your plan documents for a complete list of limitations and exclusions. Plan documents are the final arbiter of coverage. This policy provides DENTAL insurance only. Dental provider networks vary by state, by market and by plan type. Rates are guaranteed for one year for the plan of benefits initially selected. Policies renew annually. IMPORTANT INFORMATION ABOUT GUARDIAN S DENTALGUARD INDEMNITY AND DENTALGUARD PREFERRED PPO PLANS Dental PPO plans provide in-network and out-of-network benefits. Use of an in-network provider may result in reduce out of pocket costs. Coverage is limited to those charges that are necessary to prevent, diagnose or treat dental disease, defect, or injury. Deductibles apply. Waiting periods may also apply for some services. Individual dental plans do not pay for: oral hygiene services (except as covered under preventive services), orthodontia (unless expressly provided for), cosmetic or experimental treatments, any treatment to the extent benefits are payable by any other payor or for which no charge is made, prosthetic devices unless certain conditions are met, and services ancillary to surgical treatment. Individual dental plans limit benefits for diagnostic consultations and for preventive, restorative, endodontic, periodontic and prosthodontic services. Listed services, exclusions and limitations do not constitute a contract and are a summary only. IMPORTANT INFORMATION REGARDING DENTAL HMO BENEFITS Dental HMOs provide Pre-Paid dental benefits through a network of participating general dentists and specialty care dentists. All covered services must be provided by the member s Primary Care Dentist. Specialty care services are covered only when referred by the member s Primary Care Dentist and approved in advance by the Dental DHMO. Only those services listed in the Dental HMO plan are covered. Certain services are subject to annual or other periodic limitations. Where orthodontic benefits are specifically included, the plan provides for one course of comprehensive treatment per lifetime, per member. Dental HMOs do not provide orthodontic benefits if comprehensive orthodontic treatment or retention is in progress as of the member s effective date. Listed services, exclusions and limitations do not constitute a contract and are a summary only. Information on the approved state and product specific online enrollment form numbers can be viewed here: Online Enrollment Form Numbers
3 Products Underwritten by Guardian Life Insurance Company of America DENTAL PPO PLANS Policy Form IP-DEN-16 ET. AL. DENTAL HMO PLANS FLORIDA NEW YORK Policy Form IP-1-MDG-DHMO-FL-OFF-17 Policy Form IP-MDG-NY-FP-OFF-17 Products Underwritten by Managed Dental Guard, Inc. DENTAL HMO PLANS NEW JERSEY TEXAS Policy: IP-MDG-DHMO-NJ-17 Policy: IP-1-MDG-DHMO-TX-17 Products Underwritten by First Commonwealth Inc. through its Illinois subsidiaries* DENTAL HMO PLANS ILLINOIS Policy: IP-FCW-DHMO-IL-17 *First Commonwealth Insurance Company (IL), First Commonwealth Limited Health Services Corporation (IL), First Commonwealth of Illinois, Inc. Information on the approved state and product specific online enrollment form numbers can be viewed here: Online Enrollment Form Numbers
4 Accident Individual accident insurance products are underwritten by The Guardian Life Insurance Company of America, New York, New York. Products are not available in all states. Policy limitations and exclusions apply. The actual limitations and exclusions that apply to your Accident Plan are governed by the policy forms approved for use in your state. Please refer to your plan documents for a complete list of limitations and exclusions. Plan documents are the final arbiter of coverage. This policy provides limited benefits only. Rates are guaranteed for one year for the plan of benefits initially selected. Policies renew annually up to age 90. Accident Individual Policy Form IP- Accident: IP-ACC-16 et. al. Information on the approved state and product specific online enrollment form numbers can be viewed here: Online Enrollment Form Numbers
5 Critical Illness Individual Critical Illness insurance products are underwritten by The Guardian Life Insurance Company of America, New York, New York. Products are not available in all states. Policy limitations and exclusions apply. The actual limitations and exclusions that apply to your Critical Illness Plan are governed by the policy forms approved for use in your state. Please refer to your plan documents for a complete list of limitations and exclusions. Plan documents are the final arbiter of coverage. This policy provides limited benefits only. Rates are guaranteed for one year for the plan of benefits initially selected. Policies renew annually up to age 75. Critical Illness Individual Policy Form IP-CI-16 et. al. Information on the approved state and product specific online enrollment form numbers can be viewed here: Online Enrollment Form Numbers
6 Pets Best The Guardian Life Insurance Company does not own or operate Pets Best. These products are provided through a third party arrangement between Guardian and Pets Best. Pets Best underwrites, issues and administers its own products through its underwriters, American Pet Insurance Company and Independence Insurance Company. Guardian assumes no responsibility for non-guardian products or services offered by Pets Best.
7 Online Enrollment Form Numbers State Dental PPO Dental DHMO Accident Critical Illness Alabama IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Alaska Product Not Available Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Arizona IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Arkansas IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 California IP-DEN-EAPP-18-CA Product Not Available Product Not Available Product Not Available Colorado IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Connecticut IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Delaware IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 District of Columbia IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Florida IP-DEN-EAPP-16-FL IP-DEN-DHMO-EAPP-18-FL IP-ACC-EAPP-18-FL IP-CI-EAPP-18-FL Georgia IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Hawaii IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Idaho IP-DEN-EAPP-18-ID Product Not Available IP-ACC-APP-18-ID IP-CI-EAPP-18-ID Illinois IP-DEN-EAPP-18 IP-APP-FCW-DEN-IL-17 IP-ACC-APP-18-IL IP-CI-EAPP-18 Indiana IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Iowa IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Kansas IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Kentucky IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Louisiana IP-DEN-EAPP-18-LA Product Not Available IP-ACC-EAPP-18-LA IP-CI-EAPP-18-LA Maine IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Maryland Product Not Available Product Not Available Product Not Available Product Not Available Massachusetts Product Not Available Product Not Available Product Not Available Product Not Available Michigan IP-DEN-EAPP-18 Product Not Available Product Not Available Product Not Available Minnesota IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18-MN IP-CI-EAPP-18-MN Mississippi IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Missouri IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Montana Product Not Available Product Not Available IP-ACC-EAPP-18-MT IP-CI-EAPP-18-MT Nebraska IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18-NE IP-CI-EAPP-18-NE Nevada IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18-NV IP-CI-EAPP-18-NV New Hampshire IP-DEN-EAPP-18-NH Product Not Available Product Not Available Product Not Available New Jersey IP-DEN-EAPP-18-NJ Product Not Available Product Not Available Product Not Available New Mexico IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 New York IP-DEN-EAPP-18-NY IP- DEN-EAPP-18-P2-NY IP-DEN-DHMO-EAPP-18-NY IP-ACC-EAPP-18-NY Product Not Available North Carolina Product Not Available Product Not Available IP-ACC-EAPP-18-NC IP-CI-EAPP-18-NC North Dakota IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Ohio IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Oklahoma IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Oregon IP-DEN-EAPP-18-OR Product Not Available IP-ACC-EAPP-18-OR IP-CI-EAPP-18-OR Pennsylvania IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Rhode Island IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 South Carolina IP-DEN-EAPP-18-SC Product Not Available IP-ACC-EAPP-18-SC IP-CI-EAPP-18-SC South Dakota Product Not Available Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Tennessee IP-DEN-EAPP-18-TN Product Not Available IP-ACC-EAPP-18-TN IP-CI-EAPP-18-TN Texas IP-DEN-APP-16 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Utah IP-DEN-EAPP-18-UT Product Not Available IP-ACC-EAPP-18-UT IP-CI-EAPP-18-UT Vermont IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Virginia Product Not Available Product Not Available Product Not Available Product Not Available Washington IP-DEN-EAPP-18-WA Product Not Available IP-ACC-EAPP-18-WA IP-CI-EAPP-18-WA West Virginia IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Wisconsin IP-DEN-EAPP-18 Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 Wyoming Product Not Available Product Not Available IP-ACC-EAPP-18 IP-CI-EAPP-18 A9/17/18
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