Dental Plans At a Glance
2018/19 in-network plans
| Basic Dental (formerly plan 2) | Dental with Ortho (formerly plan 3) | |
|---|---|---|
| deductible | $50 per member, limited to $100 per family | $50 per member, limited to $100 per family |
| class 1 services (preventive exams, cleanings, x-rays, etc.) | 100% of approved amount within treatment limits | 100% of approved amount within treatment limits |
| class 2 services (fillings, oral surgery, root canals, etc.) | 75% of approved amount | 75% of approved amount |
| class 3 services (12-month wait period) crowns, bridges, impants, etc.) | 50% of approved amount | 50% of approved amount |
| class 4 services (orthodontic services for dependents under age 19 — 12-month wait period) | Not applicable | 50% of approved amount |
| Dollar maximums | Class 1, 2 and 3: $1,000 per member Class 4: NA |
Class 1, 2 and 3: $1,000 per member Class 4: $1,000 per member/1x lifetime |
| BENEFITS AT A GLANCE | Basic Dental BAAG | Dental with Ortho BAAG |
| Employee premiums (per pay 2x/mth) | Single: $16.21 Two-Person: $32.41 Family: $56.72 |
Single: NA Two-Person: $33.21 Family*: $58.12 |
PROVIDER INFORMATION
Blue Dental (BCBSM)
1.877.671.2583
Human Resources
Anderson-Werkman Center100 East 8th StreetSuite 210Holland, MI 49423
workP. 616.395.7811
hr@hope.edu