Gulfstream Aerospace offers two SafeGuard dental plans from which to choose ... an HMO or a PPO.
Select carefully to make sure you enroll in the plan that's right you ... you only have one opportunity a year to change plans and that's at open enrollment.
Which plan should you choose?
The following information describes the basic differences between the two plans. More specific information can be found on the Schedule and Summary of Benefits, exclusions and limitations, and in the Evidence of Coverage and Certificate of Insurance, which are included below.
Dental HMO |
Dental PPO |
Nexus 150
|
Century D1/Ortho I-10 |
| No calendar year maximums; no yearly deductibles |
$1,500 calendar year maximum;
$0 in-network yearly deductible ($0 for family);
$50 out-of-network yearly deductible
($150 for family) |
| Basic care provided by contracted general dentists selected at enrollment; changes will be effective the 1st of the following month |
You may receive treatment from any licensed dentist or receive potential savings by seeing a SafeGuard contracted dentist |
| Each family member may select a different general dentist (remember to include the facility number when enrolling) |
Non-contracted dentists may "balance bill", which could result in higher out-of-pocket costs (see the Summary of Benefits for more information) |
| Covered procedures and co-payments are listed on the Schedule of Benefits |
Claims are paid based on the percentages listed on the Summary of Benefits |
| When your selected general dentist determines you require the services of an oral surgeon, endodontist or periodontist, you can be referred directly to a SafeGuard contracted specialist with no need to contact SafeGuard for preauthorization. Orthodontic and pedodontic specialty care will require that a referral be requested from SafeGuard. |
If you require specialty care, you may see any specialty care dentist you choose; or receive care from a contracted dentist, which may help you save on expenses |
| No waiting periods |
12 month waiting period for Major services and Orthodontic Benefits for newly enrolled employees |
| Adult & child orthodontics included |
Adult & child orthodontics included: $50 deductible; $500 annual maximum; $1,000 lifetime maximum |
| No claim forms required |
Claims forms may be required |
Enrollment Instructions
During enrollment, choose one of the following plans for your dental benefit coverage:
1. SafeGuard DHMO Plan - Nexus 150
If you choose to enroll in the dental HMO plan...
- Remember to select a dentist from the SafeGuard directory for you and each of your enrolled dependents.
- Write the Facility Number in the space allotted on your enrollment form.
- A full Schedule of Benefits with co-payments and Exclusions & Limitations is included below.
- There is also an Evidence of Coverage document that provides information on how to get the most from your SafeGuard dental HMO plan.
If, after reviewing the plan documents, you have any questions, our Customer Service Representatives will be happy to help you.
800.880.1800
5 am - 6 pm, Mon-Fri.
2. SafeGuard PPO Plan - Century D1/Ortho I-10
If you decide the PPO plan is right for you, there is no need to "pre-register" with a SafeGuard dentist - you can receive treatment from any dentist, but you will save on out-of-pockets costs with a SafeGuard contracted dentist.
- Payment of claims is based on a Maximum Allowable Charge (MAC), which is set by SafeGuard and based on negotiated rates with dentists who have contracted with us. This MAC is the most that SafeGuard will pay for a particular dental procedure under a ValueChoice plan.
- Your Summary of Benefits includes the information on how payment is calculated for your plan and is included below along with the plan Exclusions & Limitations.
- A copy of the Certificate of Insurance you will receive with your ID card is also available below for your review.
If, after reviewing the plan documents, you have any questions, our Customer Service Representatives will be happy to help you.
800.880.1800
5 am - 6 pm, Mon-Fri.
