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Dental Coverage
Regular dental exams can help you and your dentist detect problems in the early stages when
treatment is simpler, and costs are lower. Keeping your teeth and gums clean and healthy will help
prevent most tooth decay and periodontal disease and is an important part of maintaining your
To find a provider
medical health.
participating in your dental
Your dental plan will be administered by Delta Dental of Michigan. plan network, visit
The Dental plan does not require use of in-network providers; however, Delta Dental network www.deltadentalmi.com
providers will charge lower fees thereby making your dental dollars go farther and lowering your out of or call 800-524-0149
pocket costs.
Delta Dental of Michigan
Plan Provision
$1,500 Plan
Annual deductible (Individual/Family) $50/$100
Annual maximum (per person) $1,500
Diagnostic and preventive care: Includes cleanings,
fluoride treatments, sealants and x-rays per plan limits 100%, no deductible
Basic Services: Includes fillings, periodontics, scaling 80% after deductible
and root planing, and oral surgery
Major Services: Includes crowns, bridges and full and
partial dentures 50% after deductible
50% after deducible,
Orthodontia (up to age 19)
$1,500 lifetime maximum
Coverage Level 2022 Dental Rates – Bi-Weekly
Employee Only $6.35
Employee +Spouse $9.20
Employee+Child(ren) $10.65
Family $15.50
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