Dental
Dental Coverage
Good dental care improves your overall health. Our dental plan is designed to help you maintain a healthy smile through regular dental care and fix any problems as soon as they occur.
PPO Plan
The dental plan offers you the freedom and flexibility to choose any licensed dentist. You receive the greatest savings when you visit a Delta Dental PPO or Delta Dental Premier in-network provider. If you visit an out-of-network provider, you will pay a percentage of the Reasonable and Customary (R&C) fee based on the provider’s rates. Find an in-network provider at deltadentalmi.com. Dental ID cards are not provided.
| | Delta Dental | Delta Dental |
|---|---|---|
| Plan Features | Delta Dental PPO or Premier Dentist | Non-Participating Dentist* |
| Plan Pays | Plan Pays | |
| Calendar Year Deductible | None | None |
| Calendar Year Maximum | $1,500 | |
| Preventive Services | 100% | 100% |
| (exams, cleanings, x-rays) | ||
| Basic Services | 80% | 80% |
| (fillings, extractions, root canals) | ||
| Major Services | 50% | 50% |
| (crowns, dentures, bridges, implants) | ||
| Orthodontia | 50% | 50% |
| (children to age 19) | ||
| Orthodontia Lifetime Maximum | $1,000 | $1,000 |
*When you receive services from a Non-Participating Dentist, the percentages in this column indicate the portion of Delta Dental’s Non-Participating Dentist Fee that will be paid for those services. This amount may be less than what the Dentist charges or Delta Dental approves and you are responsible for that difference.
See the Benefits Guide or benefit summaries for detailed plan information.
Your payroll deductions for dental and vision are shown here.
Delta Dental
Delta Dental of Michigan Dental Plan
| Employee Cost | Monthly | Per Pay Period |
|---|---|---|
| Employee Only | $10.67 | $5.34 |
| Employee + Spouse | $20.14 | $10.07 |
| Employee + Child(ren) | $24.80 | $12.40 |
| Employee + Family | $38.06 | $19.03 |
Reminder: You will not receive a physical ID card, but a generic digital ID card is available for download when you log in to your account on the Delta Dental website or app.
Dental Provider Network: Delta Dental PPO or Delta Dental Premier
Dental Group ID #: 9981
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