2023 Blue DentalSM PPO 100/50/50 with Vision

This plan picks up where most medical insurance leaves off. Preventive dental care like exams and cleanings are covered at 100 percent when you see an in-network dentist, and adult vision care has copays as low as $10.

Overview

About this plan

This plan provides everyone in the family with dental care and adults age 19 and older with dental and vision care for one monthly payment. It also gives you the choice to see out-of-network dentists and vision providers, but you pay more out of pocket.

Availability

You can buy this plan if you live in any Michigan county.

Unlike most other Blue Cross plans, Blue Dental PPO 100/50/50 with Vision isn't available on healthcare.gov.

Plan type

PPO. For dental care, you can go to any licensed dentist and this plan will share the cost. But you'll pay less if you see a Tier 1 PPO in-network dentist.

VSP. For vision care, you can go to any eye doctor and this plan will share the cost. But you'll pay less if you see a VSP eye doctor.

Monthly premiums

To give you an accurate price, we'll need some information. Find a plan to get a quote.

Deductible for dental care

Class I services have no deductible. There is a deductible for Class II and III services only. Class IV services are not covered.

  In Network Out of Network
One member You pay $25 You pay $50
Two members You pay $50 You pay $100
Three members You pay $75 You pay $150


Your deductible is the amount you pay for dental services each year before your insurance begins to pay.

Coinsurance for dental care

  In Network Out of Network
Class I You pay $0 You pay 50%
Class II You pay 50% after deductible You pay 50% after deductible
Class III You pay 50% after deductible You pay 50% after deductible
Class IV You pay 100% You pay 100%


Your coinsurance is your share of the costs of a service. It's usually figured as a percentage of the amount we allow to be charged for services. You start paying coinsurance after you’ve met your plan’s deductible.

Annual benefit maximum for adult dental care

In Network Out of Network
$1,200 total for each adult Up to $800 of the $1,200 total can be used toward out-of-network care.

This is the limit on what your plan pays for dental care benefits for members who are 19 or older when their plan starts. After reaching that limit for the year, you pay for 100% of your dental care.

Annual out-of-pocket max for pediatric dental care

  In Network Out of Network
One member You pay no more than $375 Not applicable
Two members or more You pay no more than $750 Not applicable

This out-of-pocket maximum is the most you’ll have to pay during a calendar year for covered pediatric dental services. Once you’ve reached this out-of-pocket maximum, your plan pays 100 percent of the allowed amount.

Adult vision care

Coverage includes:

  • One eye exam every 12 months
  • One pair of standard frames every 24 months

You choose between coverage for prescription glasses (lenses and frame) or contact lenses, but not both:

  • Contacts covered once every 12 months, or
  • One pair of standard lenses covered once every 12 months


Costs include:

  • Copay is $10 for an eye exam by an in-network provider.  
  • If you go to an in-network provider, the copay for glasses is $25 and you have a $130 allowance for frames or elective contact lenses.

Agent compensation

Members can find information about agent commissions.

Overview

About this plan

This plan provides everyone in the family with dental care and adults age 19 and older with dental and vision care for one monthly payment. It also gives you the choice to see out-of-network dentists and vision providers, but you pay more out of pocket.

Availability

You can buy this plan if you live in any Michigan county.

Unlike most other Blue Cross plans, Blue Dental PPO 100/50/50 with Vision isn't available on healthcare.gov.

Plan type

PPO. For dental care, you can go to any licensed dentist and this plan will share the cost. But you'll pay less if you see a Tier 1 PPO in-network dentist.

VSP. For vision care, you can go to any eye doctor and this plan will share the cost. But you'll pay less if you see a VSP eye doctor.

Monthly premiums

To give you an accurate price, we'll need some information. Find a plan to get a quote.

Deductible for dental care

Class I services have no deductible. There is a deductible for Class II and III services only. Class IV services are not covered.

  In Network Out of Network
One member You pay $25 You pay $50
Two members You pay $50 You pay $100
Three members You pay $75 You pay $150


Your deductible is the amount you pay for dental services each year before your insurance begins to pay.

Coinsurance for dental care

  In Network Out of Network
Class I You pay $0 You pay 50%
Class II You pay 50% after deductible You pay 50% after deductible
Class III You pay 50% after deductible You pay 50% after deductible
Class IV You pay 100% You pay 100%


Your coinsurance is your share of the costs of a service. It's usually figured as a percentage of the amount we allow to be charged for services. You start paying coinsurance after you’ve met your plan’s deductible.

Annual benefit maximum for adult dental care

In Network Out of Network
$1,200 total for each adult Up to $800 of the $1,200 total can be used toward out-of-network care.

This is the limit on what your plan pays for dental care benefits for members who are 19 or older when their plan starts. After reaching that limit for the year, you pay for 100% of your dental care.

Annual out-of-pocket max for pediatric dental care

  In Network Out of Network
One member You pay no more than $375 Not applicable
Two members or more You pay no more than $750 Not applicable

This out-of-pocket maximum is the most you’ll have to pay during a calendar year for covered pediatric dental services. Once you’ve reached this out-of-pocket maximum, your plan pays 100 percent of the allowed amount.

Adult vision care

Coverage includes:

  • One eye exam every 12 months
  • One pair of standard frames every 24 months

You choose between coverage for prescription glasses (lenses and frame) or contact lenses, but not both:

  • Contacts covered once every 12 months, or
  • One pair of standard lenses covered once every 12 months


Costs include:

  • Copay is $10 for an eye exam by an in-network provider.  
  • If you go to an in-network provider, the copay for glasses is $25 and you have a $130 allowance for frames or elective contact lenses.

Agent compensation

Members can find information about agent commissions.

Actions

Download or print your benefit information.

Choose your dental coverage for 2023.

Enroll now

Get help choosing a plan

Our health plan advisors can help you choose a plan, calculate your costs and tell you whether you're eligible for a subsidy. You can watch this video to meet your health plan advisors.

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