Dental Plans At a Glance
2023/24 in-network plans
| Basic Dental | Dental with Ortho | |
|---|---|---|
| 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 | 100% of approved amount |
| class 2 services (fillings, simple oral surgery, root canals, etc.) | 75% of approved amount | 75% of approved amount |
| class 3 services (surgical services, crowns, bridges, impants, etc. ) | 50% of approved amount | 50% of approved amount |
| class 4 services (orthodontic services for dependents under age 19) | Not applicable | 50% of approved amount |
| Dollar maximums | Class 1, 2 and 3: $1,500 per member Class 4: NA |
Class 1, 2 and 3: $1,500 per member Class 4: $1,500 per member/1x lifetime |
| BENEFITS AT A GLANCE | Basic Dental BAAG | Dental with Ortho BAAG |
| Employee premiums (per pay 2x/mth) | Single: $14.21 Two-Person: $28.42 Family: $49.73 |
Single: NA Two-Person: $29.81 Family: $52.17 |
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