Tax Disclosure:

Guardian, its subsidiaries, agents, and employees do not provide tax, legal, or accounting advice. Consult your tax, legal, or accounting professional regarding your individual situation.

Logo and Copyright Disclosure:

Guardian® is a registered trademark of The Guardian Life Insurance Company of America, New York, NY. ©Copyright 2021 The Guardian Life Insurance Company of America, New York, N.Y.

New York Disclosure:

  • Accident: This policy provides Accident insurance only. IMPORTANT NOTICE -THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS. GP-1-AC-BEN-12, GP-1-ACC-18, et al.
  • Critical Illness: This policy provides limited benefits health insurance only. GP-1-CI-14. In New York Critical Illness is known as Specified Disease. 
  • Specified Disease: This policy or certificate provides specified disease coverage ONLY. GP-1-CI-14 
  • Hospital Indemnity: This policy provides limited hospital insurance only. GP-1-HI-15
  • Long Term Disability: This policy only provides disability income insurance. GP-1-LTD-15
  • Short Term Disability: This policy only provides disability income insurance. GP-1-STD-15
  • Dental: This policy only provides DENTAL insurance. GP-1-DG2000, et al
  • Vision:  This policy only provides vision care limited benefits health insurance. GP-1-GVSN-17

These policies do not provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services.

Accident Insurance:

Guardian's Accident Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY.  Products are not available in all states.  Policy limitations and exclusions apply.  Optional riders and/or features may incur additional costs.  Plan documents are the final arbiter of coverage.  This policy provides Accident insurance only.  It does not provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services. IMPORTANT NOTICE –THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS. Policy Form GP-1-AC-BEN-12, et al.

When an advertisement refers to either a dollar amount, a period of time for which any benefit is payable, the cost of the policy, a specific policy benefit, or the loss for which such benefit is payable, then the following limitations and exclusions must be included:

Summary of plan limitations and exclusions

This plan will not pay benefits for any injury caused by or related to:

  • Declared or undeclared war, act of war, or armed aggression; taking part in a riot or civil disorder; or commission of, or attempt to commit a felony; Intentionally self-inflicted injury, while sane or insane; suicide or attempted suicide, while sane or insane
  • Service in the armed forces, National Guard, or military reserves of any state or country
  • Voluntary use of any poison, chemical, prescription or nonprescription drug or controlled substance unless: (1) it was prescribed for a covered person by a doctor, and (2) it was used as prescribed. In the case of a nonprescription drug, this Plan does not pay for any Accident resulting from or contributed to by use in a manner inconsistent with package instructions. "Controlled substance" means anything called a controlled substance in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as amended from time to time.
  • The covered person being intoxicated
  • Travel or flight in any kind of aircraft, including any aircraft owned by or for the employer except as a fare-paying passenger on a common carrier
  • Participation in any kind of sporting activity for compensation or profit, including coaching or officiating
  • Riding in or driving any motor-driven vehicle in a race, stunt show or speed test
  • Participation in hang gliding, bungee jumping, sailgliding, parasailing, parachuting, parakiting, ballooning, zorbing, and/or skydiving
  • Job related or on the job injuries (if applicable)
  • Injuries to a dependent child received during the birth
  • An accident that occurred before the covered person is covered by this plan
  • Sickness, disease, mental infirmity or medical or surgical treatment
  • Employees must be legally working in the United States in order to be eligible for coverage. Underwriting must approve coverage for employees on temporary assignment: (a) exceeding one year; or (b) in an area under travel warning by the U.S. Department of State, subject to state specific variations.
  • For full plan features, including exclusions and limitations, please refer to your policy.

Child organized sports benefit (if applicable)

The child must be insured by the plan in the state the accident occurred. The child must be 18 years of age or younger.

The Rainy Day Fund

The Rainy Day Fund does not apply to benefits without frequency limitations, or Wellness claims. Covered benefits include: air ambulance, ambulance, blood/plasma/platelets, chiropractic visits, diagnostic exam (major), doctor follow-up visits, emergency dental work, epidural anesthesia pain management, eye injury, family care, fractures, gunshot wound, hospital confinement, hospital ICU confinement, joint replacement, knee cartilage, lodging, outpatient therapies, rehabilitation unit confinement, ruptured disc with surgical repair, surgery (cranial, open abdominal, thoracic, hernia), surgery (exploratory and arthroscopic), transportation, and x-ray if they are included on your plan.

Cancer Insurance:

Guardian's Cancer Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY.  Products are not available in all states.  Policy limitations and exclusions apply.  Optional riders and/or features may incur additional costs.  Plan documents are the final arbiter of coverage.  This policy provides limited benefits health insurance only.  It does not provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services. Policy Form # GP-1-CAN-IC-12The Group Policy form number varies by state depending on whether the Cancer Insert or Rewrite set of forms was approved.

When an advertisement refers to either a dollar amount, a period of time for which any benefit is payable, the cost of the policy, a specific policy benefit, or the loss for which such benefit is payable, then the following limitations and exclusions must be included:

Summary of plan limitations and exclusions

  • In order to be eligible for coverage: Employees must be legally working (a) in the United States or (b) outside the United States, for a US based employer, in a country or region approved by Guardian.
  • State variations may apply.
  • A pre-existing condition includes any condition for which an employee, in the specified time period prior to coverage in this plan, consults with a physician, receives treatment, or takes prescribed drugs. Please refer to the plan documents for specific time periods. State variations may apply.
  • Cancer diagnosed prior to the Cancer Insurance effective date.
  • This plan will not pay benefits for (State variations may apply):
  • Services or treatment not included in the Schedule of Insurance
  • Services or treatment provided by a family member
  • Services or treatment rendered for hospital confinement outside the United States
  • Any cancer diagnosed solely outside of the United States
  • Services or treatment provided primarily for cosmetic purposes
  • Services or treatment for premalignant conditions
  • Services or treatment for conditions with malignant potential
  • Services or treatment for non-cancer sicknesses
  • Cancer caused by, contributed to by, or resulting from: participating in a felony, riot or insurrection; intentionally causing a self-inflicted injury; committing or attempting to commit suicide while sane or insane; a covered person’s mental or emotional disorder, alcoholism or drug addiction; engaging in any illegal activity; or serving in the armed forces or any auxiliary unit of the armed forces of any country
  • Cancer arising from war or act of war, even if war is not declared
  • For plans with an annual open enrollment, applicants may enroll once a year during the open enrollment period specified by the policy. Applicants who seek to enroll outside of an annual open enrollment period must submit an evidence of insurability form.  For plans without an open enrollment period, any person seeking to enroll more than 31 days after the effective date of coverage must submit an evidence of insurability form.  Evidence of insurability forms require applicants to answer questions about their health.

Wyoming Cancer Required Disclosure

Right to Return: If you are not satisfied, you may return the certificate within 30 days after receipt. The amount of premium you have paid will be refunded provided no claim has been incurred during the 30-day period. Your certificate will then be void, as though you had never applied for the insurance.

Proof of Insurability: If your plan requires proof of insurability, it will be shown in the schedule of insurance. Your coverage may not become effective until you submit proof of insurability to us.

Pre-Existing Conditions: If your plan has a pre-existing condition limitation, it will be shown in your certificate. A pre-existing condition is a cancer, whether diagnosed or misdiagnosed, for which in the 90 days before you become covered by this plan, you: (1) received advice or treatment from a doctor; (2) underwent diagnostic procedures; (3) were prescribed or took prescription drugs; or (4) received other medical care or treatment, including consultation with a doctor. This plan will not pay benefits for cancer that is caused by, or results from, a pre-existing condition if the cancer occurs during the first 12 months that you are covered by this plan.

Exclusions: This plan will not pay benefits for the following: services or treatment not included in the schedule of insurance; services or treatment provided by a family member; services or treatment provided primarily for cosmetic purposes; services or treatment for premalignant conditions; services or treatment for conditions with malignant potential; services or treatment for non-cancer sicknesses; cancer caused by, contributed to by, or resulting from: (1) participating in a felony, riot or insurrection; (2) intentionally causing a self-inflicted injury; (3) committing or attempting to commit suicide while sane or insane; (4) your mental or emotional disorder, alcoholism or drug addiction; or (5) engaging in any illegal activity; or (6) serving in the armed forces or any auxiliary unit of the armed forces of any country; cancer arising from war or act of war, even if war is not declared.

Benefits: Your plan may include the following benefits: air ambulance; alternative care (palliative care or Lifestyle benefits); ambulance; anesthesia; anti-nausea medication; attending doctor; blood, plasma and platelets; bone marrow and stem cells; cancer screening, cancer screening follow-up; experimental treatment; extended care facility/skilled nursing care; government or charity hospital; home health care; hormone therapy; hospital confinement;  immunotherapy; intensive care unit confinement; inpatient special nursing; medical imaging; outpatient and family member lodging; outpatient or ambulatory surgical center; physical or speech therapy; prosthetic devices; radiation therapy and chemotherapy; reconstructive surgery; reproductive benefits; second surgical opinion; skin cancer; surgical benefits; and transportation/companion transportation.

Critical Illness Insurance:

Guardian's Critical Illness Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY.  Products are not available in all states.  Policy limitations and exclusions apply.  Optional riders and/or features may incur additional costs.  Plan documents are the final arbiter of coverage. This policy provides limited benefits health insurance only.  It does not provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services.  Policy Form # GP-1-CI-14.

When an advertisement refers to either a dollar amount, a period of time for which any benefit is payable, the cost of the policy, a specific policy benefit, or the loss for which such benefit is payable, then the following limitations and exclusions must be included:

Summary of plan limitations and exclusions

2014 Critical Illness - List of Exclusions:

The policy has exclusions and limitations that may impact the eligibility for or entitlement to benefits under each covered condition. There are limitations & special requirements for each condition. See the certificate of coverage or contact your sales representative for full details.

This policy will not pay for a diagnosis of a listed critical illness that is made before the covered person’s Critical Illness effective date with Guardian.

  • We will not pay benefits for the First Occurrence of a Critical Illness if it occurs less than 3 months after the First Occurrence of a related Critical Illness for which this Plan paid benefits. By related we mean either: (a) both Critical Illnesses are contained within the Cancer Related Conditions category; or (b) both Critical Illnesses are contained within the Vascular Conditions category; or (c) both Critical Illnesses are contained within the Childhood Conditions category.
  • We will not pay benefits for a second occurrence (recurrence) of a Critical Illness unless the Covered Person has not exhibited symptoms or received care or treatment for that Critical Illness for at least 12 months in a row prior to the recurrence. For purposes of this exclusion, care or treatment does not include: (1) preventive medications in the absence of disease; and (2) routine scheduled follow-up visits to a Doctor.
  • We do not pay for a third or later occurrence of a critical illness.
  • First & second occurrence refers to the first & second time an insured experiences or is diagnosed with a covered critical illness while covered under Guardian Critical Illness insurance.
  • A pre-existing condition includes any condition for which an employee, in the specified period of time prior to coverage in this plan, consults with a physician, receives treatment, or takes prescribed drugs. Please refer to the plan documents for specific time periods. State variations may apply.
  • If the plan is new (not transferred): During the exclusion period, this critical illness plan does not pay charges relating to a preexisting condition. If this plan is transferred from another insurance carrier, the time an insured is covered under that plan will count toward satisfying Guardian’s pre-existing condition limitation period. Please refer to the plan details for specific time periods. State variations may apply.
  • We do not pay benefits for charges relating to a covered person: taking part in any war or act of war (including service in the armed forces), committing a felony or taking part in any riot or other civil disorder or intentionally injuring themselves or attempting suicide while sane, or insane.
  • In order to be eligible for coverage: Employees must be legally working: (a) in the United States or (b) outside the United States, for a US based employer, in a country or region approved by Guardian. Subject to state specific variations.
  • Employees must be working full-time on the effective date of coverage; otherwise, coverage becomes effective after the completion of the specific waiting period.
  • Health questions are required for all late enrollees. Benefit increases may require underwriting. (**NOTE – Not included when Open Enrollment/Perpetual GI is sold)
  • An applicant must enroll within 31 days of the coverage effective date. An annual open enrollment will occur each year during a time period specified by the policyholder. If the applicant enrolls outside of the annual open enrollment period they will be considered a late entrant and must answer health questions. (**NOTE - Only included when Open Enrollment/Perpetual GI is sold)
  • This coverage will not be effective until approved by a Guardian underwriter.  Please refer to certificate of coverage for full plan description; plan documents are the final arbiter of coverage.

Dental Insurance:

Commercial group:

DentalGuard Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY.  Products are not available in all states.  Policy limitations and exclusions apply.  Optional riders and/or features may incur additional costs.  Plan documents are the final arbiter of coverage.  This policy provides DENTAL insurance only. Policy Form # GP-1-DG2000, et al., GP-1-DEN-16.

When an advertisement refers to either a dollar amount, a period of time for which any benefit is payable, the cost of the policy, a specific policy benefit, or the loss for which such benefit is payable, then the following limitations and exclusions must be included:

Exclusions & limitations:

Important Information about Guardian's DentalGuard Indemnity and DentalGuard Preferred PPO Plans:  This policy provides dental insurance only.  Coverage is limited to those charges that are necessary to prevent, diagnose or treat dental disease, defect, or injury.  Depending on plan type, deductibles, waiting periods, per service frequency limitations, and payment limits may apply. The plan does 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.  The plan limits benefits for diagnostic, preventive, restorative, endodontic, periodontic, prosthodontic, oral surgery and adjunctive general services.  The services, exclusions, and limitations listed above do not constitute a contract and are a summary only.  The Guardian plan documents are the final arbiter of coverage.

Managed Care products underwritten by Guardian subsidiaries:

All products, unless otherwise noted, are underwritten by The Guardian Life Insurance Company of America ('Guardian') or one of the following wholly owned Guardian Subsidiaries: Managed Dental Care (CA); First Commonwealth Insurance Company (IL); First Commonwealth Limited Health Services Corporation (IN); First Commonwealth Limited Health Services Corporation of Michigan (MI); First Commonwealth of Missouri, Inc. (MO) and Managed DentalGuard, Inc. (NJ, OH and TX). Any reference to a specific product type, including but not limited to 'DHMO' or 'Prepaid' is not intended to refer to a specific state license designation, but rather is merely intended to refer to a general product design. Such DHMO, or prepaid products, are licensed in the applicable jurisdiction. In addition, certain products are underwritten by Dominion Dental Services, Inc. (DC, DE, MD, PA and VA) and LIBERTY Dental Plan of Nevada, Inc. (NV). Please see the applicable policy forms for details. In the event of conflict between this proposal and the policy forms, the policy forms shall control.

When an advertisement refers to either a dollar amount, a period of time for which any benefit is payable, the cost of the policy, a specific policy benefit, or the loss for which such benefit is payable, then the following limitations and exclusions must be included:

Summary of plan limitations and exclusions

Managed Care DHMO Standard Plans

  • The list of dental services shown is not exhaustive. 
  • Except for limited emergency services, benefits will be provided for services provided by the primary care dentist selected by the member. The member must pay the primary care dentist a patient charge/copayment for most covered services. No benefits will be paid for treatment by a specialist unless the patient is referred by his or her primary care dentist and the referral is approved by the plan.
  • This plan provides managed care dental benefits through a network of participating general dentists and specialty care dentists.
  • Only those services listed in the plan’s schedule of benefits are covered.
  • Certain Services are subject to frequency or other periodic limitations.
  • Where orthodontic benefits are specifically included, the plan provides for one course of comprehensive treatment per member.
  • Unless specifically included, the plan does not provide orthodontic benefits if comprehensive orthodontic treatment or retention is in progress as of the member’s effective date under the plan.
  • The services, exclusions and limitations listed above do not constitute a contract and are a summary only. The plan documents are the final arbiter of coverage.

Policy Form #:

    • For S series FCW: INS GMC 11/97
    • For all U series: FCW-GMC-et al., GP-1-MDG-et al., GP-1-MDC-et al.
    • For all N series: GP-1-DHMO-16-et al.

Long Term Disability Insurance:

Guardian’s Group Long Term Disability Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY.  Products are not available in all states.  Policy limitations and exclusions apply.  Optional riders and/or features may incur additional costs. This policy provides disability income insurance only. Plan documents are the final arbiter of coverage. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services. Policy Form # GP-1-LTD-15.

When an advertisement refers to either a dollar amount, a period of time for which any benefit is payable, the cost of the policy, a specific policy benefit, or the loss for which such benefit is payable, then the following limitations and exclusions must be included:

Summary of plan limitations and exclusions

  • We limit the duration of payments for long term disabilities caused by mental or emotional conditions, or alcohol or drug abuse.
  • We do not pay benefits for charges relating to a covered person: taking part in any war or act of war (including service in the armed forces); committing a felony or taking part in any riot or other civil disorder; intentionally injuring themselves or attempting suicide while sane or insane; and for the voluntary inhalation or ingestion of poison, gas, solvent, chemical, or other substance not intended for internal consumption
  • We do not pay benefits due solely to the risk of relapse, during any period in which a covered person is confined to a correctional facility; an employee is not under the care of a doctor; an employee is receiving treatment outside of the U.S. or Canada; or the employee’s loss of earnings is not solely due to disability.
  • During the exclusion/limitation period, this disability plan does not pay charges relating to a pre-existing condition. If this plan is transferred from another insurance carrier, the time an insured is covered under that plan will count toward satisfying Guardian’s pre-existing condition exclusion/limitation period. A pre-existing condition includes any condition for which an employee, in a specified period of time prior to coverage in this plan, consults with a physician, receives treatment, or takes prescribed drugs. Please refer to the plan details for specific time periods.
  • In order to be eligible for coverage, employees must be legally working (a) in the United States or (b) outside the United States, for a U.S. based employer in a country or region approved by Guardian.
  • This policy provides disability income insurance only. It does not provide "basic hospital," "basic medical," or "major medical" insurance as defined by the New York State Insurance Department.
  • Evidence of insurability is required for all late enrollees. 
  • Please refer to certificate of coverage for full plan description; plan documents are the final arbiter of coverage.

Short Term Disability Insurance:

Guardian’s Group Short Term Disability Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY.  Products are not available in all states.  Policy limitations and exclusions apply.  Optional riders and/or features may incur additional costs. This policy provides disability income insurance only.  It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services. Plan documents are the final arbiter of coverage. Policy Form # GP-1-STD-15.

When an advertisement refers to either a dollar amount, a period of time for which any benefit is payable, the cost of the policy, a specific policy benefit, or the loss for which such benefit is payable, then the following limitations and exclusions must be included:

Summary of plan limitations and exclusions

  • We do not pay benefits for charges relating to a covered person: taking part in any war or act of war (including service in the armed forces) committing a felony or taking part in any riot or other civil disorder; intentionally injuring themselves or attempting suicide while sane or insane; and for the voluntary inhalation or ingestion of poison, gas, solvent, chemical, or other substance not intended for internal consumption.  
  • We do not pay benefits due solely to the risk of relapse, during any period in which a covered person is confined to a correctional facility; an employee is not under the care of a doctor; an employee is receiving treatment outside of the U.S. or Canada; the employee’s loss of earnings is not solely due to disability.
  • During the exclusion/limitation period, this disability plan does not pay charges relating to a pre-existing condition.  If this plan is transferred from another insurance carrier, the time an insured is covered under that plan will count toward satisfying Guardian’s pre-existing condition exclusion/limitation period. Please refer to the plan details for specific time periods. A pre-existing condition includes any condition for which an employee, in a specified period of time prior to coverage in this plan, consults with a physician, receives treatment, or takes prescribed drugs.
  • In order to be eligible for coverage, employees must be legally working (a) in the United States or (b) outside the United States, for a U.S. based employer in a country or region approved by Guardian. Subject to state specific variations.
  • This policy provides disability income insurance only.  It does not provide "basic hospital," "basic medical," or "major medical" insurance as defined by the New York State Insurance Department.
  • Please refer to certificate of coverage for full plan description; plan documents are the final arbiter of coverage.

Hospital Indemnity Insurance:

Guardian Hospital Indemnity Insurance is underwritten by The Guardian Life Insurance Company of America, New York, NY.  Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. Plan documents are the final arbiter of coverage. This policy provides limited hospital insurance only. It does not provide basic medical or major medical insurance as defined by the New York State Department of Financial Services. Policy Form # GP-1-HI-15.

Summary of plan limitations and exclusions

  • In order to be eligible for coverage: Employees must be legally working: (a) in the United States or (b) outside the United States, for a US based employer, in a country or region approved by Guardian.
  • Employees must be working full-time on the effective date of coverage; otherwise, coverage becomes effective after the completion of the specific waiting period.
  • An applicant must enroll within 31 days of the coverage effective date.  An open enrollment will occur each year during a time period specified by the policyholder. If an applicant does not enroll during their initial enrollment period, he/she may not enroll until the next open enrollment period.
  • A pre-existing condition includes any condition for which a covered person, in the look back period prior to coverage in this plan, (1) receives advice or treatment from a doctor; (2) undergoes diagnostic procedures, other than routine screening in the absence of symptoms or suspicion of disease process by a doctor; (3) are prescribed or take prescription drugs; or (4) receives other medical care or treatment, including consultation with a doctor. No benefit will be paid until the earlier of a specified amount of treatment free time or after the insured is covered for a certain number of months. Please refer to the plan documents for specific time periods. State variations may apply.
  • If the plan is new (not transferred): During the exclusion period, this Hospital Indemnity plan does not pay charges relating to a pre-existing condition. If this plan is transferred from another insurance carrier, the time an insured is covered under that plan will count toward satisfying Guardian's pre-existing condition limitation period. Please refer to the plan details for specific time periods. State variations may apply.

And this plan will not pay benefits for: (State Variations Apply)

  • Treatment relating to a covered person: taking part in any war or act of war (including service in the armed forces), commission of or attempt to commit a felony, an act of terrorism, or participating in an illegal occupation, riot or insurrection;
  • Suicide or any intentionally self-inflicted injury;
  • Elective surgery;
  • Surgery to correct vision or hearing, unless a result of a covered Injury, medically necessary surgery for glaucoma, cataracts or other sickness or injury;
  • Dental care, dental x-rays, or dental treatment;
  • Gastric or intestinal bypass services including lap banding, gastric stapling, and other similar procedures to facilitate weight loss; the reversal, or revision of such procedures; or services required for the treatment of complications from such procedures. This exclusion does not apply to completion of a weight reduction program that may be payable under the Health Screening benefit;
  • Rest cures or custodial care, or treatment of sleep disorders;
  • Cosmetic surgery. This exclusion does not apply to reconstructive surgery: on an injured part of the body following infection or disease of the involved part; of a congenital disease or anomaly of a covered dependent newborn or adopted infant; or on a non-diseased breast to restore and achieve symmetry between two breasts following a covered Mastectomy;
  • Treatment or removal of warts, moles, boils, skin blemishes or birthmarks, bunions, acne, corns, calluses, the cutting and trimming of toenails, care for flat feet, fallen arches or chronic foot strain;
  • Service, treatment or loss related to alcoholism or drug addiction, except for drugs prescribed by the covered person’s doctor and taken as prescribed;
  • Care or treatment for mental or nervous disorders;
  • Services, treatment or loss rendered in any veterans administration or federal hospital, except if there is a legal obligation to pay;
  • Services or treatment provided by a doctor, nurse or any other person who is employed or retained by a covered person or covered person’s spouse, parent, brother, sister, child, domestic partner or partner in a civil union;
  • Surgery and treatment, procedures, products or services that are experimental or investigative;
  • Hospital Confinement and/or Hospital Admission due to any covered person’s giving birth within the first nine months after the covered person’s effective date under this Plan as a result of a normal pregnancy, including cesarean section. Complications of pregnancy will be covered to the same extent as any other covered sickness; (**NOTE – Included when the Maternity/Pregnancy Exclusion is quoted as “Normal pregnancy included with 9 Month limit”)
  • Treatment of a covered dependent child’s children;
  • Sickness or injury sustained while on active duty in the armed forces of any country. This does not include Reserve or National Guard duty for training.

Group Term Life Insurance:

Guardian Group Life Insurance underwritten and issued by The Guardian Life Insurance Company of America, New York, NY.  Products are not available in all states.  Policy limitations and exclusions apply.  Optional riders and/or features may incur additional costs.  Plan documents are the final arbiter of coverage. Policy Form # GP-1-LIFE-15.

AD&D product; can be offered as a stand-alone. Generic Policy Form # GP-1-ADD-15.

When an advertisement refers to either a dollar amount, a period of time for which any benefit is payable, the cost of the policy, a specific policy benefit, or the loss for which such benefit is payable, then the following limitations and exclusions must be included:

Summary of plan limitations and exclusions

Voluntary Life Plan

  • In order to be eligible for coverage: Employees must be legally working (a) in the United States or (b) outside the United States, for a U.S. based employer, in a country or region approved by Guardian.
  • We pay no benefits if the insured’s death is due to suicide within two years from the insured’s original effective date. This two year limitation also applies to any increase in benefit. This exclusion may vary according to state law.
  • Employees must be working full-time on the effective date of coverage; otherwise, coverage becomes effective after the completion of the specific waiting period.
  • Evidence of insurability is required for all late enrollees, and for certain voluntary life insurance plans. When evidence of insurability is required, the coverage is subject to underwriting. 
  • Please refer to certificate of coverage for full plan description; plan documents are the final arbiter of coverage.
  • We pay no Accidental Death and Dismemberment benefits for an insured where death or dismemberment occurs as the result of a disease or a bodily infirmity; through willful self-injury; by declared or undeclared war, act of war, armed aggression, or while a member of armed forces; while driving a motor vehicle unlicensed, or with a license that has been revoked, suspended or expired for more than 90 days; while legally intoxicated; while participating in civil disorder or committing a felony; traveling on any type of aircraft while having any duties on that aircraft, while voluntarily using a non-prescription controlled substance.

Vision Insurance:

Guardian’s Vision Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY.  Products are not available in all states.  Policy limitations and exclusions apply.  Optional riders and/or features may incur additional costs.  This policy provides vision care limited benefits health insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services.  Plan documents are the final arbiter of coverage. Policy Form # GP-1-GVSN-17.

When an advertisement refers to either a dollar amount, a period of time for which any benefit is payable, the cost of the policy, a specific policy benefit, or the loss for which such benefit is payable, then the following limitations and exclusions must be included:

Summary of plan limitations and exclusions – Guardian Vision with the Davis Vision Network

  • Coverage is limited to those charges that are necessary to prevent, diagnose and treat a vision condition.
  • Members cannot bank unused allowance amounts for future use; they must use their allowance during the same office visit. 
  • Members cannot split their benefits; they must purchase frames and lenses during the same office visit.
  • The plan does not pay for:
  • Orthoptics or vision training and any associated supplemental testing
  • Medical or surgical treatment of the eye
  • Eye examination or corrective eyewear required by an employer as a condition of employment
  • Lenses and frames furnished under this plan, which are lost or broken (except when services are otherwise available)
  • Designer plans limit benefits for most optional cosmetic lens processes and treatments. Our plans cover a wide range of cosmetic lens processes and treatments
  • Medically necessary contact lenses are covered only if needed: (1) after cataract surgery; (2) to correct extreme visual acuity problems that cannot be corrected with eyeglasses; (3) for certain conditions of Anisometropia; or (4) for Keratoconus
  • The services, exclusions and limitations listed above do not constitute a contract and are a summary only.
  • Plan documents are the final arbiter of coverage.

When an advertisement refers to either a dollar amount, a period of time for which any benefit is payable, the cost of the policy, a specific policy benefit, or the loss for which such benefit is payable, then the following limitations and exclusions must be included:

Summary of plan limitations and exclusions – Guardian Vision with the VSP Network

  • Coverage is limited to those charges that are necessary to prevent, diagnose and treat a vision condition.
  • Members cannot bank unused allowance amounts for future use, they must use their allowance during the same office visit.
  • The plan does not pay for:
  • Orthoptics or vision training and any associated supplemental testing.
  • Medical or surgical treatment of the eye
  • Eye examination or corrective eyewear required by an employer as a condition of employment
  • Lenses and frames furnished under this plan, which are lost or broken (except when services are otherwise available)
  • The plan limits benefits for blended lenses, oversized lenses, photochromic lenses, coated or laminated lenses, a frame that exceeds plan allowance, cosmetic lenses, U-V protected lenses, and optional cosmetic processes
  • Medically necessary contact lenses are covered only if needed: (1) after cataract surgery; (2) to correct extreme visual acuity problems that cannot be corrected with eyeglasses; (3) for certain conditions of Anisometropia; or (4) for Keratoconus
  • The services, exclusions and limitations listed above do not constitute a contract and are a summary only.
  • Plan documents are the final arbiter of coverage.

College Tuition Benefit:

The Tuition Rewards program is provided by SAGE CTB, LLC. Guardian does not provide any services related to this program. SAGE CTB, LLC is not a subsidiary or an affiliate of Guardian. Guardian reserves the right to discontinue the College Tuition Benefit program at any time without notice. The College Tuition Benefit is not an insurance benefit and may not be available in all states. College Tuition Benefit is available for qualifying Guardian Dental, Guardian Vision, Hospital Indemnity, LTD, STD, Life, Critical Illness, Cancer and Accident insurance.

Employee Assistance Program:

Work Life Matters Program services are provided by Integrated Behavioral Health, Inc., and its contractors. Guardian does not provide any part of WorkLifeMatters program services. Guardian is not responsible or liable for care or advice given by any provider or resource under the program. This information is for illustrative purposes only. It is not a contract. Only the Administration Agreement can provide the actual terms, services, limitations and exclusions. Guardian and IBH reserve the right to discontinue the Work Life Matters program at any time without notice. Legal services provided through Work Life Matters will not be provided in connection with or preparation for any action against Guardian, IBH, or your employer. The Work Life Matters program is not an insurance benefit and may not be available in all states.

TravelAid:

TravelAid services are provided by Integrated Behavioral Health, Inc., and UnitedHealthcare Global. The Guardian Life Insurance Company of America (Guardian) does not provide any part of TravelAid services. Guardian is not responsible or liable for care or advice given by any provider or resource under the program. This information is for illustrative purposes only. It is not a contract. Only the policy can provide the actual terms, services, limitations and exclusions. We are not responsible for availability, quality, result of or failure to provide any medical, legal or other care or service caused by conditions beyond Our control. Guardian and IBH reserve the right to discontinue TravelAid at any time. TravelAid services may not be available in all states.

Will Preparation Services:

WillPrep Services are provided by Integrated Behavioral Health, Inc., and its contractors. The Guardian Life Insurance Company of America (Guardian) does not provide any part of WillPrep Services. Guardian is not responsible or liable for care or advice given by any provider or resource under the program. This information is for illustrative purposes only. It is not a contract. Only the Administration Agreement can provide the actual terms, services, limitations and exclusions. Guardian and IBH reserve the right to discontinue the WillPrep Services at any time without notice. Legal services will not be provided in connection with or preparation for any action against Guardian, IBH, or your employer. WillPrep Services is not an insurance benefit and may not be available in all states.

Wellness Benefit:

One Wellness Benefit per calendar year per covered person if a covered person has a covered wellness test or procedure performed while coverage is in force. See your plan details for benefit amounts.

Digital Health Coach (IBH):

Digital Health Coach is a program designed, operated and owned by Integrated Behavioral Health, Inc., and its affiliates.  Guardian has contracted with Integrated Behavioral Health, Inc. for the delivery of the Digital Health Coach program to our members.  Guardian does not provide content or administer the Digital Health Coach program.  Guardian is not responsible or liable for services or advice given by any aspect of the Digital Health Coach program. Each user’s participation in the Digital Health Coach program is subject to Integrated Behavioral Health, Inc. terms and conditions that must be agreed upon to be a participant in the program. Guardian and IBH reserve the right to discontinue the Digital Health Coach program at any time without notice.

EMMA External Use:

EMMA is a trademark of Guardian and cannot be used without express written authorization. ©2021 The Guardian Life Insurance Company of America.

Benefit Administration (BenAdmin)

– Not to be used if the Ben Admin Firm is contracted as Guardian’s TPA:

All benefits administration services advertised herein are performed by independent service providers that are neither subsidiaries nor affiliates of The Guardian Life Insurance Company of America. Guardian is neither responsible nor liable for the performance of these services.

byte®:

The Guardian Life Insurance Company does not own or operate byte®. These products are provided through a third-party arrangement between Guardian and byte®. Guardian assumes no responsibility for non-Guardian products or services offered by byte®.

Nayya:

Advertised services are performed by Nayya, an independent, third party service provider that is neither a subsidiary nor affiliate of The Guardian Life Insurance Company of America. Guardian is neither responsible nor liable for services, advice or recommendations made by Nayya.

Third-Party Site Links:

Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.

Reviewed on 8/31/21

Disclaimer

Guardian® is a registered trademark of The Guardian Life Insurance Company of America.

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