Home » Insurance » Dental » Option I

Dental

Delta Dental Plan of Michigan Option I

For a rate quote or enrollment information contact the MLBMA Agency, L.L.C.  at (517) 394-5225 ext. 105 or 106 or by email at jodi@mlbma.org

Plan Pays You Pay CLASS I Diagnostic and Preventive Services - Used to diagnose and/or prevent dental abnormalities or disease (includes exams, cleanings, and fluoride treatments). 100% 0% Emergency Palliative Treatment - Used to temporarily relieve pain. 100% 0% Sealants - Dental sealants to prevent decay of permanent molars (to age nine on first molars and age 14 on second molars). 100% 0% CLASS II Radiographs - X-rays. 80% 20% Oral Surgery Services - Extractions and dental surgery, including preoperative and postoperative care. 80% 20% Minor Restorative Services - Used to repair teeth damaged by disease or injury (for example, amalgam [silver] and resin [white] fillings). 80% 20% Periodontics - Used to treat diseases of the gums and supporting structures of the teeth. 80% 20% Endodontics - Used to treat teeth with diseased or damaged nerves (for example, root canals). 80% 20% CLASS III Prosthodontics - Used to replace missing natural teeth (for example, bridges and dentures). 50% 50% Major Restorative Services - Used when teeth cannot be restored with another filling material (for example, crowns). 50% 50% CLASS IV Orthodontic Services (to age 19) - Used to correct malposed teeth and/or facial bones (for example, crowns). 50% 50% Maximum Payment - $1,000 per person total per calendar year for Class I, Class II, and Class III Benefits. Delta Dental's payment for Class IV Benefits will not exceed a lifetime maximum of $1,000 per eligible person. Deductible - $50 per person total per calendar year limited to a maximum deductible of $150 per family per calendar year on Class II and Class III Benefits. The deductible does not apply to Class I or Class IV Benefits.