2023 Blue DentalSM PPO 80/50/50 with Vision
This plan picks up where most medical insurance leaves off. You get dental coverage for all ages, and adult vision care with copays as low as $10.
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.
You can buy this plan if you live in any Michigan county.
Unlike most other Blue Cross plans, Blue Dental PPO 80/50/50 with Vision isn't available on healthcare.gov.
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.
To give you an accurate price, we'll need some information. Find a plan to get a quote.
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.
| In Network | Out of Network | |
| Class I | You pay 20% | 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.
| 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.
| 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.
You choose between coverage for prescription glasses (lenses and frame) or contact lenses, but not both:
Members can find information about agent commissions.
Adult members are age 19 or older at the start of the coverage year.
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.
Preventive care like exams and cleanings. There is no waiting period for Class I services.
Dental exams
Visits are covered twice a year.
| In Network | Out of Network |
| You pay 20% | You pay 50% |
Teeth cleaning (prophylaxis)
Cleanings are covered twice a year.
| In Network | Out of Network |
| You pay 20% | You pay 50% |
Bitewing X-rays
A set of four films is covered once a year.
| In Network | Out of Network |
| You pay 20% | You pay 50% |
Fluoride treatments
Not covered
Basic services like fillings and root canals. These services are covered six months after you first join a Blue Dental plan.
Periodontal maintenance
Limited to twice a year in combination with routine cleaning.
| In Network | Out of Network |
| You pay 50% | You pay 50% |
Fillings
Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth.
| In Network | Out of Network |
| You pay 50% | You pay 50% |
Simple extractions
| In Network | Out of Network |
| You pay 50% | You pay 50% |
Root canals
Covered once per tooth per lifetime.
| In Network | Out of Network |
| You pay 50% | You pay 50% |
Major services like crowns and bridges. These services are covered 12 months after you first join a Blue Dental plan.
Oral surgery
This includes all oral surgery except simple extractions, which are covered in Class II.
| In Network | Out of Network |
| You pay 50% | You pay 50% |
Crowns, onlays, veneer fillings
Covered once per tooth every 60 months.
| In Network | Out of Network |
| You pay 50% | You pay 50% |
Bridges and dentures
Covered once per arch every 84 months.
| In Network | Out of Network |
| You pay 50% | You pay 50% |
Implants
Not covered
Orthodontic services
Not covered
Children can get pediatric benefits until the end of the calendar year in which they turn 19. There is no waiting period for pediatric dental.
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.
Preventive care like exams and cleanings.
Dental exams
Visits are covered twice a year.
| In Network | Out of Network | |
| You pay 20% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Teeth cleaning (prophylaxis)
Cleanings are covered three times a year.
| In Network | Out of Network | |
| You pay 20% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Bitewing X-rays
A set of four films is covered once a year.
| In Network | Out of Network | |
| You pay 20% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Fluoride treatments
Fluoride treatments are covered twice a year for members to the end of the month of their 19th birthday.
| In Network | Out of Network | |
| You pay 20% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Basic services like fillings and root canals.
Sealants
Sealants are covered once per fully erupted first and second permanent molar every 36 months for members to the end of the month of their 16th birthday.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Space maintainers
Space maintainers are covered once per quadrant every two years for members to the end of the month of their 15th birthday.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Periodontal maintenance
Limited to three times a year in combination with routine cleaning.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Fillings
Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Simple extractions
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Root canals
Covered once per tooth per lifetime.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Major services like crowns and bridges.
Oral surgery
This includes all oral surgery except simple extractions, which are covered in Class II.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Crowns, onlays, veneer fillings
Covered once per tooth every 60 months.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Bridges and dentures
Complete dentures covered once per arch every 84 months; partial dentures and bridges covered once per arch every 84 months for members age 16 and older.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Implants
Not covered
Orthodontic services
Not covered
When you go to an eye doctor who participates with VSP, that's called getting your care in network. Find a VSP eye doctor.
You're also covered when you go to an eye doctor who doesn't participate with VSP, but you'll pay more. That's called getting your care out of network.
There's a limit on what your plan pays toward the cost of eyeglasses or contacts. It's called an annual allowance. Once you've reached that limit, you're responsible for paying all costs.
Eye exams are covered once every 12 months.
| In Network | Out of Network |
| You pay $10 | You pay $10 plus any costs over $45. |
Every 12 months this plan shares the costs for prescription eyeglasses or contact lenses, but not both.
Standard lenses
Standard lenses prescribed by an eye doctor, optometrist or optician are covered once every 12 months.
A single copay applies to both lenses and frames.
| In Network | Out of Network |
| You pay $25 | You pay $25, plus the costs listed below. |
Single vision lenses: You pay costs over $30. |
|
Bifocal lenses: You pay costs over $50. |
|
Trifocal lenses: You pay costs over $65. |
Standard frames
Standard frames are covered once every 24 months.
A single copay applies to both lenses and frames.
| In Network | Out of Network |
| You pay $25, plus costs over $130 | You pay $25, plus costs over $70 |
Every 12 months, this plan shares the costs for eyeglasses or contact lenses, not both.
Elective contact lenses
Elective contact lenses are prescribed by an eye doctor, optometrist or optician to improve vision. They are covered once every 12 months.
| In Network | Out of Network |
| You pay any costs over $130 | You pay any costs over $105 |
Medically necessary contact lenses
Medically necessary contact lenses are for people with eye conditions that may be a side effect of an operation or from certain genetically related disorders. They are covered once every 12 months.
| In Network | Out of Network |
| You pay $25 | You pay $25 plus costs over $210 |
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.
You can buy this plan if you live in any Michigan county.
Unlike most other Blue Cross plans, Blue Dental PPO 80/50/50 with Vision isn't available on healthcare.gov.
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.
To give you an accurate price, we'll need some information. Find a plan to get a quote.
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.
| In Network | Out of Network | |
| Class I | You pay 20% | 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.
| 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.
| 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.
You choose between coverage for prescription glasses (lenses and frame) or contact lenses, but not both:
Members can find information about agent commissions.
Adult members are age 19 or older at the start of the coverage year.
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.
Preventive care like exams and cleanings. There is no waiting period for Class I services.
Dental exams
Visits are covered twice a year.
| In Network | Out of Network |
| You pay 20% | You pay 50% |
Teeth cleaning (prophylaxis)
Cleanings are covered twice a year.
| In Network | Out of Network |
| You pay 20% | You pay 50% |
Bitewing X-rays
A set of four films is covered once a year.
| In Network | Out of Network |
| You pay 20% | You pay 50% |
Fluoride treatments
Not covered
Basic services like fillings and root canals. These services are covered six months after you first join a Blue Dental plan.
Periodontal maintenance
Limited to twice a year in combination with routine cleaning.
| In Network | Out of Network |
| You pay 50% | You pay 50% |
Fillings
Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth.
| In Network | Out of Network |
| You pay 50% | You pay 50% |
Simple extractions
| In Network | Out of Network |
| You pay 50% | You pay 50% |
Root canals
Covered once per tooth per lifetime.
| In Network | Out of Network |
| You pay 50% | You pay 50% |
Major services like crowns and bridges. These services are covered 12 months after you first join a Blue Dental plan.
Oral surgery
This includes all oral surgery except simple extractions, which are covered in Class II.
| In Network | Out of Network |
| You pay 50% | You pay 50% |
Crowns, onlays, veneer fillings
Covered once per tooth every 60 months.
| In Network | Out of Network |
| You pay 50% | You pay 50% |
Bridges and dentures
Covered once per arch every 84 months.
| In Network | Out of Network |
| You pay 50% | You pay 50% |
Implants
Not covered
Orthodontic services
Not covered
Children can get pediatric benefits until the end of the calendar year in which they turn 19. There is no waiting period for pediatric dental.
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.
Preventive care like exams and cleanings.
Dental exams
Visits are covered twice a year.
| In Network | Out of Network | |
| You pay 20% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Teeth cleaning (prophylaxis)
Cleanings are covered three times a year.
| In Network | Out of Network | |
| You pay 20% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Bitewing X-rays
A set of four films is covered once a year.
| In Network | Out of Network | |
| You pay 20% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Fluoride treatments
Fluoride treatments are covered twice a year for members to the end of the month of their 19th birthday.
| In Network | Out of Network | |
| You pay 20% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Basic services like fillings and root canals.
Sealants
Sealants are covered once per fully erupted first and second permanent molar every 36 months for members to the end of the month of their 16th birthday.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Space maintainers
Space maintainers are covered once per quadrant every two years for members to the end of the month of their 15th birthday.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Periodontal maintenance
Limited to three times a year in combination with routine cleaning.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Fillings
Limited to once every 24 months for primary teeth, and once every 48 months for permanent teeth.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Simple extractions
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Root canals
Covered once per tooth per lifetime.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Major services like crowns and bridges.
Oral surgery
This includes all oral surgery except simple extractions, which are covered in Class II.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Crowns, onlays, veneer fillings
Covered once per tooth every 60 months.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Bridges and dentures
Complete dentures covered once per arch every 84 months; partial dentures and bridges covered once per arch every 84 months for members age 16 and older.
| In Network | Out of Network | |
| You pay 50% before meeting your out-of-pocket max, and $0 after meeting your out-of-pocket max. | You pay 50% |
Implants
Not covered
Orthodontic services
Not covered
When you go to an eye doctor who participates with VSP, that's called getting your care in network. Find a VSP eye doctor.
You're also covered when you go to an eye doctor who doesn't participate with VSP, but you'll pay more. That's called getting your care out of network.
There's a limit on what your plan pays toward the cost of eyeglasses or contacts. It's called an annual allowance. Once you've reached that limit, you're responsible for paying all costs.
Eye exams are covered once every 12 months.
| In Network | Out of Network |
| You pay $10 | You pay $10 plus any costs over $45. |
Every 12 months this plan shares the costs for prescription eyeglasses or contact lenses, but not both.
Standard lenses
Standard lenses prescribed by an eye doctor, optometrist or optician are covered once every 12 months.
A single copay applies to both lenses and frames.
| In Network | Out of Network |
| You pay $25 | You pay $25, plus the costs listed below. |
Single vision lenses: You pay costs over $30. |
|
Bifocal lenses: You pay costs over $50. |
|
Trifocal lenses: You pay costs over $65. |
Standard frames
Standard frames are covered once every 24 months.
A single copay applies to both lenses and frames.
| In Network | Out of Network |
| You pay $25, plus costs over $130 | You pay $25, plus costs over $70 |
Every 12 months, this plan shares the costs for eyeglasses or contact lenses, not both.
Elective contact lenses
Elective contact lenses are prescribed by an eye doctor, optometrist or optician to improve vision. They are covered once every 12 months.
| In Network | Out of Network |
| You pay any costs over $130 | You pay any costs over $105 |
Medically necessary contact lenses
Medically necessary contact lenses are for people with eye conditions that may be a side effect of an operation or from certain genetically related disorders. They are covered once every 12 months.
| In Network | Out of Network |
| You pay $25 | You pay $25 plus costs over $210 |
Download or print your benefit information.
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.
1. Chat with an advisor online now.
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