Page 8 - Michigan Fitness Foundation 2021 Booklet
P. 8
Michigan Fitness Foundation
January 2021 Dental Renewal
Current Renewal
Blue Cross Blue Shield Blue Cross Blue Shield
PPO Plus 100/80/50/50 $1000 SG PPO Plus 100/80/50/50 $1000 SG
Plan Type PPO PPO
Plan Year 2020 2021
In-Network In-Network
Deductible
Family $75 $50/$75
Individual $25 $25
Class 1 - Preventive 0% 0%
Class 2 - Basic 20% 20%
Class 3 - Major 50% 50%
Class 4 - Orthodontic 50% 50%
Orthodontic Lifetime Maximum $1000 $1000
Annual Maximum $1000 $1000
Waiting Period
Provider Network Blue Dental PPO Blue Dental PPO
Effective Date 1/1/2020 1/1/2021
Total Number of Employees 31 31
Monthly Total Dental Premium $2,068.21 $1,921.11
Annual Total Dental Premium $24,818.52 $23,053.32
Percentage Change From Current -7.11%
Annual Dollar Change From Current ($1,765.20)