Orthodontic benefits are issued throughout the length of treatment in equal quarterly installments while the plan remains active.
The first quarterly payment can be issued when the initial claim is received. The information required for the initial claim is listed below.
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Length of treatment
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Date the appliance was placed
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Estimated cost of the treatment
An orthodontic payment will be automatically paid every 3 months until the end of the treatment, as long as the patient is still eligible.
Additional plan details
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Retainers are covered once and only if it is not included in the total cost of treatment. Replacements are not covered.
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Work ups are a covered orthodontic service, subject to the plan's benefits.
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Treatment in progress (when the appliance was placed prior to your effective date) will be considered. The benefit payments are prorated based on when the appliance was placed and your effective date.
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Guardian will coordinate benefits when the combined orthodontic payments between the primary insurance and the Guardian plan exceed the total treatment fee.
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Invisalign is a covered orthodontic benefit, but you will be liable for the difference between the cost of traditional metal braces and Invisalign braces.
Note: For a full list of plan details, limitations and exclusions, review your certificate booklet.