Dental | Sparrow Health System Benefits

MNA Home Care RNs-Represented Caregivers

Dental Benefits Overview

Benefit	Plan Description	Key Features	What’s New This Year?
Delta Dental Plan Rate Sheet Enrollment/Change Forms Silver (Base) Plan Summary Gold (Buy-Up) Plan Summary	Preferred provider network (PPO), which allows you to have services performed either in or out of the Delta Dental Network. Silver (Base) plan provides a wide network of dentists; covers 100% of preventive exams and cleaning, 50% of X-rays, and has a $1,000 of Annual Maximum of coverage from Delta Dental. Gold (Buy-Up) plan provides a wide network of dentists; covers 100% of preventative services, child & adult orthodontics has a $1,500 lifetime maximum of coverage, and the plan has $1,500 Annual Maximum of coverage from Delta Dental. Allows for wide network of dentists with 100% coverage for of preventative care and $1,500 of annual coverage.	Silver (Base) plan with Gold (Buy-Up) plan option. Large network of dentists and dental specialists. Caregivers are able to choose their own dental provider within the PPO network. Search the Delta Dental Provider directory to find providers; choose PPO for Silver (Base) and Gold (Buy-Up) plans. The Dental and Vision plans are no longer linked. If you elect a dental plan, you will no longer automatically be enrolled in a vision plan. Likewise, if you elect a vision plan, you no longer are required to elect a dental plan.	Plan names have changed! The new names are: Silver (Base) Gold (Buy Up)

Benefit

Plan Description

Key Features

What’s New This Year?

Delta Dental Plan
Rate Sheet

Enrollment/Change Forms

Silver (Base) Plan Summary

Gold (Buy-Up) Plan Summary

Preferred provider network (PPO), which allows you to have services performed either in or out of the Delta Dental Network.

Silver (Base) plan provides a wide network of dentists; covers 100% of preventive exams and cleaning, 50% of X-rays, and has a $1,000 of Annual Maximum of coverage from Delta Dental.

Gold (Buy-Up) plan provides a wide network of dentists; covers 100% of preventative services, child & adult orthodontics has a $1,500 lifetime maximum of coverage, and the plan has $1,500 Annual Maximum of coverage from Delta Dental.

Allows for wide network of dentists with 100% coverage for of preventative care and $1,500 of annual coverage.

Silver (Base) plan with Gold (Buy-Up) plan option. Large network of dentists and dental specialists. Caregivers are able to choose their own dental provider within the PPO network.

Search the Delta Dental Provider directory to find providers; choose PPO for Silver (Base) and Gold (Buy-Up) plans.

The Dental and Vision plans are no longer linked. If you elect a dental plan, you will no longer automatically be enrolled in a vision plan. Likewise, if you elect a vision plan, you no longer are required to elect a dental plan.

Plan names have changed! The new names are: Silver (Base) Gold (Buy Up)

For Information Call:

Total Rewards Hotline

517-364-5333

[email protected]

This is a summary of the benefits provided by each insurance carrier and it is not intended to fully describe the details of each benefit plan. Should any questions arise, the contracts in effect will take precedence.