Page 5 - Mi Health and Hospital 2021 Renewal Booklet.2

Michigan Health & Hospital Association: Dental Cost Analysis
Effective January 2021

Current Renewal
Delta Dental PPO Delta Dental PPO
$1500 Annual Max $1500 Annual Max
Rates Counts
Single 33 $38.25 $38.25
Employee + 1 37 $76.63 $76.63
Family 71 $144.67 $144.67
Estimated Monthly Premium $14,369.13 $14,369.13
Estimated Annual Premium $172,429.56 $172,429.56
Percentage Change 0.00%
Annual Dollar Change $0.00
Deductible In-Network In-Network
Individual $0 $0
Family $0 $0
Maximum Payment
Individual $1,500 $1,500
Family $1,500 per member $1,500 per member
Diagnostic & Preventative 100% 100%
Basic Services 75% 75%
Major Services 50% 50%
Orthodontics 50% 50%
Lifetime Maximum Ortho $2,000 per member (no age limit) $2,000 per member (no age limit)

This is a summary analysis only. Refer to certificate of coverage for all specific details.
This summary is not a contract and makes no representations or warranties as to final outcomes of claim adjudication.
Rates do not include the Michigan Claims Tax.
Rate hold through December 31, 2021