National Plans Form | Dental & Vision Plans

National Plan Enrollment Form

Individual Rates	Value	Standard	Preferred
Individual	$9.94	$18.95	$27.94
Individual & Spouse	$19.89	$37.89	$55.87
Individual & Child(ren)	$25.32	$48.22	$71.12
Individual & Family	$38.74	$73.78	$108.83

Argus Dental & Vision, Inc. (Argus) is a subsidiary of Aflac Incorporated. Argus holds licenses, registrations, and/or certificates of authority to act as a Prepaid Limited Health Service Organization (PLHSO) in Florida, Discount Medical Plan Organization in Florida, Discount Health Care Program Operator in Texas, Employee Benefit Plan Administrator (EBPA) in Wisconsin, an agency in Florida (License No. L096749), and as a third party administrator (TPA) in most U.S. jurisdictions. Argus is licensed in New York State as a life broker (License No. 1630554) and conducts business in New York State under the name Argus Administrative Services.

Argus provides administrative services to or on behalf of health plans, government agencies, and insurance companies. Argus provides administrative services for dental and vison coverages underwritten by American Family Life Assurance Company of Columbus. In addition, Argus provides administrative services for dental and vision coverages underwritten by National Guardian Life Insurance Company. National Guardian Life Insurance Company is not affiliated with the Guardian Life Insurance Company of America also known as The Guardian or Guardian Life. Coverage underwritten by American Family Life Assurance Company of Columbus is offered in all U.S. jurisdictions, except CO, KY, MA, MD, MT, NC, NJ, NM, NY, PA, VA, RI, WA, Puerto Rico, Guam, or Virgin Islands. Coverage underwritten by National Guardian Life Insurance Company is offered in FL, LA, CA, MI, IL, GA, NC, OH, PA, and TX.

Notice to Consumer: This is a limited benefit plan and provides dental and/or vision benefits only. Aflac’s contracts of insurance, including Aflac’s network dental and vision plans, provide limited-scope and/or supplemental benefits only and do not constitute comprehensive health insurance coverage. Aflac’s contracts of insurance do not satisfy the requirement of minimum essential coverage under the Patient Protection and Affordable Care Act (ACA) and are not designed to meet any of the essential health benefit requirements mandated by the ACA or federal law, including pediatric oral or vision care services. Aflac’s contracts of insurance are not an alternative to, or a substitute for, comprehensive health insurance coverage and should only be used to supplement comprehensive health insurance coverage.

Argus Dental & Vision, Inc. | Tampa, FL

AGC200051R1

EXP 3/22

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