Dental | Sparrow Health System Benefits

Non-Union Caregivers

Dental Benefits Overview

Benefit	Plan Description	Key Features	What’s New This Year?
Delta Dental Plan Rate Sheet Enrollment/Change Forms Base Plan Summary Buy-Up Plan Summary EPO Summary	Preferred Provider Network (PPO), which allows you to have services performed either in or out of the Delta Dental’s network of dentists. 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. Buy-Up plan provides a wide network of dentists; covers 100% of preventative services, child & adult orthodontics and has a $1,500 of Annual Maximum of coverage from Delta Dental. EPO plan has an exclusive network of providers – it works like an HMO so that you do not need to choose a primary dentist and there is no Annual Maximum for general services. Preventive services are covered 100% in-network.	Base plan with 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 Base and Buy-Up plans, and EPO for the new EPO plan. EPO Plan Find an EPO dentist here: http://search.providers4you.com/epo 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.	The following coverage enhancements apply to the EPO Plan only: – Posterior Composite Resin Fillings – Posterior Porcelain Crowns/Bridges – Occlusal Guards: 1 in 5 years – Special Healrh Care Needs Benefit

Benefit

Plan Description

Key Features

What’s New This Year?

Delta Dental Plan
Rate Sheet

Enrollment/Change Forms

Base Plan Summary

Buy-Up Plan Summary

EPO Summary

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

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.

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

EPO plan has an exclusive network of providers – it works like an HMO so that you do not need to choose a primary dentist and there is no Annual Maximum for general services. Preventive services are covered 100% in-network.

Base plan with 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 Base and Buy-Up plans, and EPO for the new EPO plan.

EPO Plan

Find an EPO dentist here: http://search.providers4you.com/epo

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.

The following coverage enhancements apply to the EPO Plan only:

– Posterior Composite Resin Fillings
– Posterior Porcelain Crowns/Bridges
– Occlusal Guards: 1 in 5 years
– Special Healrh Care Needs Benefit

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.