Section 5 - STATE SPONSORED GROUP INSURANCE PLANS
|DENTAL CARE OPTIONS|
|You may select one of the following plans.
Information describing specific plan benefits, exclusions and limitations are available from the benefit plan administrator. Toll free numbers and web addresses are listed in Section 14.
If you are a seasonal, part-time, permanent intermittent or job sharing employee -- or if you are a State employee married to another State employee/retiree -- see Section 10, Employee Eligibility.
Dental Comparison Chart
STATE DENTAL PLAN - Delta Dental Plan of Michigan
The State will cover 95% of the total premium,* and you will pay the remaining 5% premium charge via payroll deductions. Please refer to the FY 2014-2015 Insurance Premium Rates Chart.
This plan covers preventive services (exams and cleanings) at 100% of the "usual, customary and reasonable charge;" radiographs (x-rays), oral surgery, extractions, restoratives, periodontics, and endodontics at 90%; orthodontics at 60%; and sealants for children and prosthodontics (including repairs) at 50%. You are responsible for paying any remaining charges for these services. (This is your co-payment.) These charges may be higher if you obtain services from a non-participating dentist.
This plan will pay a total of $1,500 in basic benefits per member each benefit year (October - September). There is a separate lifetime maximum of $1,500 payable per member for orthodontics.
|PREVENTIVE DENTAL PLAN - Delta Dental Plan of Michigan
The State will cover the full premium cost of this plan* and, if you are enrolled, you will receive a $100 lump-sum rebate. Please refer to the FY 2014-2015 Insurance Premium Rates Chart.
This preventive care plan covers diagnostic exams, x-rays and cleanings to the same extent as the State Dental Plan. However, no other services are covered. This plan is intended as an option if you are over-insured because you have dental coverages elsewhere (for example, through a spouse who works for a non-State employer).
You can use the licensed dental care provider of your choice. However, dentists who participate under a provider contract with the dental vendor have agreed to accept the vendor's scheduled reimbursement; non-participating dentists have not.
NOTE: If your spouse's (non-State) employer will not cover you under their group dental plan because you are enrolled in either of the State-sponsored dental care options, including the Preventive Dental Plan, you can "opt out" completely and still receive the $100 lump-sum rebate. Select "Dental Waiver with Rebate".
If you are enrolled in the Preventive Dental Plan and your coverages are terminated mid-year, you will have to return - via a deduction from your pay check -- a pro-rata portion of any lump sum rebate you received (because it was originally paid to you up front for the full 12-month enrollment). Conversely, if you newly enroll in the Preventive Dental Plan mid-year because of a family status change, you will receive a payment on a pro-rata basis following your new enrollment.
|DENTAL MAINTENANCE ORGANIZATION (DMO)- (Midwestern Dental Plans)
The State will cover the full premium cost of this plan.* No payroll deductions are required. Please refer to the FY 2014-2015 Insurance Premium Rates Chart.
This is a managed care dental plan that provides all necessary dental care and services at Midwestern Dental Plans' dental care centers. There are no member co-payments required for any covered dental care received at a dental center, except for a $1,250 orthodontics co-payment for adults (age 19 and older). There are no benefit maximums.
You can choose your own DMO service center which serves your residential area, and which will provide your personal dental care or make referrals for oral surgery, prosthodontics, periodontics, orthodontics or other services. Most of the dental centers -- located in Wayne, Oakland, Macomb and Ingham counties -- are open for business during evening hours and on Saturdays. In addition, a 24-hour phone service is available for emergency care. For out-of-area emergencies, the DMO will cover 50% of reasonable charges for the immediate relief of pain and suffering.
Review the DMO postal code list for service areas listed by zip code. Benefit plan materials are available directly from the Midwestern Dental Plans at 800-544-6374 (toll-free).
*Except for those employees in certain bargaining units who are hired on or after 1/1/00 who have a regular work schedule of 40 hours or less per bi-weekly pay period (not permanent-intermittent positions).
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