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 only covers dental care you get from dentists in our nationwide preferred network. For vision care, you can see any VSP eye doctor.

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

Unlike most other Blue Cross plans, Blue Dental EPO 80/50/50 (0/0/0) with Vision isn't available on healthcare.gov.

EPO. Your dental care is only covered if you see a Tier 1 PPO in-network dentist. There's no out-of-network coverage.

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.

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

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.

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.

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.

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.

Members can find information about agent commissions.

All-Ages Dental Certificate of Coverage (PDF)
Vision for Adults Certificate of Coverage (PDF)

Adult members are age 19 or older at the start of the coverage year.

Your dental care is only covered if you see a Tier 1 PPO in-network dentist. There is no out-of-network coverage.

Preventive care like exams and cleanings. There is no waiting period for Class I services.

Dental exams
Visits are covered twice a year.

Teeth cleaning (prophylaxis)
Cleanings are covered twice a year.

Bitewing X-rays
A set of four films is covered once a year.

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.

Fillings
Limited to once per tooth and surface every 24 months for primary teeth, and once per tooth and surface every 48 months for permanent teeth.

Simple extractions

Root canals
Covered once per tooth per lifetime.

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.

Crowns, onlays, veneer fillings
Covered once per tooth every 60 months.

Bridges and dentures
Covered once per arch every 84 months.

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.

Your dental care is only covered if you see a Tier 1 PPO in-network dentist. There is no out-of-network coverage.

Preventive care like exams and cleanings.

Dental exams
Visits are covered twice a year.

Teeth cleaning (prophylaxis)
Cleanings are covered three times a year.

Bitewing X-rays
A set of four films is covered once a year.

Fluoride treatments
Fluoride treatments are covered twice a year for members to the end of the month of their 19th birthday.

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.

Space maintainers
Space maintainers are covered once per quadrant every two years for members to the end of the month of their 15th birthday.

Periodontal maintenance
Limited to three times a year in combination with routine cleaning.

Fillings

Limited to once per tooth and surface every 24 months for primary teeth, and once per tooth and surface every 48 months for permanent teeth.

Simple extractions

Root canals
Covered once per tooth per lifetime.

Major services like crowns and bridges.

Oral surgery
This includes all oral surgery except simple extractions, which are covered in Class II.

Crowns, onlays, veneer fillings
Covered once per tooth every 60 months.

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.

Implants
Not covered

Orthodontic services
Not covered