Page 9 - 2022 Benefit Guide Bronx
P. 9
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
To find a provider
your medical health.
participating in your dental
Your dental plan will be administered by Delta Dental of Michigan. plan network, visit
www.deltadentalmi.com
The Dental plan does not require use of in-network providers; however, Delta Dental network
or call 800-524-0149
providers will charge lower fees thereby making your dental dollars go farther and lowering your
out of pocket costs.
Download the APP for easy
access to claims, virtual ID
Delta Dental of Michigan Card, plan benefits and
Plan Provision
$1,500 Plan more.
Annual deductible (Individual/Family) $50/$100
Annual maximum (per person) $1,500
Diagnostic and preventive care: Includes
cleanings, fluoride treatments, sealants and x- 100%, no deductible
rays per plan limits
Basic Services: Includes fillings, periodontics, 80% after deductible
scaling and root planing, and oral surgery
Major Services: Includes crowns, bridges and 50% after deductible
full and partial dentures
50% after deducible,
Orthodontia (up to age 19)
$1,500 lifetime maximum
Covered by Fives Bronx No Employee Premium
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