Overview
Healthy teeth and gums are important to your overall wellbeing. To help you maintain your dental health and address any issues, our dental coverage through Delta Dental of Michigan pays for most preventive and diagnostic care and helps pay for the cost of basic and major restorative treatments. The plan also provides orthodontia benefits for dependents up to the age of 19 (unless they are medically necessary).
Key features at a glance:
Free in-network preventive and diagnostic care,
with no deductible.
Affordable coverage
that helps you manage the cost of dental treatment.
Wide network of providers
that have agreed to negotiated rates, which helps you save money.
Find a network dentist
You'll generally pay less out-of-pocket when you use an in-network dentist. Visit Delta Dental of Michigan for more information.
Learn how using in-network providers can help you save here.
Coverage Details
| Feature | Amount |
|---|---|
| Deductible | |
| Employee only | $50 |
|
Employee + spouse/declared domestic partner
or
Employee + child
|
$100 |
Employee + children or Employee + family (Employee + spouse/declared domestic partner + child(ren)) | $150 |
| Annual maximum benefit paid per calendar year excluding orthodontics | $2,000 |
| Lifetime maximum benefit paid for orthodontics | $2,000 |
| Services | |
|
Class I benefits:
Diagnostic and preventive services (includes exams, cleanings, fluoride and space maintainers); emergency palliative treatment; sealants; radiographs/X-rays; periodontal cleanings
|
You pay $0 |
|
Class II benefits:
Minor restorative services (includes fillings); periodontic services (to treat gum disease); endodontic services (includes root canals); oral surgery services (extractions and dental surgery); relines and repairs (to bridges and dentures); other basic services
|
You pay 20%, plan pays 80% |
|
Class III benefits:
Major restorative services (includes crowns); prosthodontic services (includes bridges and dentures); implants (endosteal implants to replace missing teeth)
|
You pay 50%, plan pays 50% |
Class IV benefits: Orthodontic services (includes braces) Note: Orthodontic age limit is 19 unless medically necessary. | You pay 50%, plan pays 50% |
Where to go for care
With your dental plan, you have the freedom to choose any licensed dentist for care. However, if you choose a Delta Dental Premier or Delta Dental PPO dentist, you will pay only your copayment for covered services. To find a Delta Dental Premier or Delta Dental PPO dentist, check Delta Dental of Michigan’s web site.
Using your dental benefits
Here’s how to make the most of your dental benefits:
Choose a provider.
Each time you need dental care, you have a choice of providers. Selecting a Delta Dental of Michigan participating dentist will ensure you receive the highest benefits from your plan. To find a provider, go to Delta Dental of Michigan.
Present your plan identification information at your provider’s office.
The group number is 5480.
If your service will exceed $200, submit for a pre-treatment estimate.
You should always submit a request for a pre-treatment estimate for procedures and services your dentist believes will exceed $200 (procedures such as crowns, inlays, bridges, and periodontics). For more information about pre-treatment estimates, call Delta Dental of Michigan at 800-524-0149 or visit Delta Dental of Michigan.
Check your claim status and other information at Delta Dental of Michigan.
You can review Explanation of Benefits (EOB) statements, check if claims have been paid, and more.
Visit Delta Dental of Michigan to download additional forms.