Personal Blue DentalSM
Overview
| Eligibility | Individuals and family members not enrolled in Flexible Blue II or Individual Care Blue Plus* |
| Monthly Rate | Starting at $37.53 |
| Copay: | Preventive services: 25 percent Basic restorative services: 50 percent Major restorative services: 50 percent |
| Deductible: | $50 single/$100 family (two or more) per calendar year on basic and restorative services |
| Annual Maximums: | $1,250 per member for all covered services received in-network |
| Waiting Period: | 6-month waiting period on Class II – Basic Restorative and Class III – Major Restorative services, applied on the effective date of dental coverage |
| Network: | PPO dental network** |
*If you are currently enrolled in Flexible Blue II or Individual Care Blue Plus medical coverage you are not eligible for this product. We do offer Flexible Blue Dental for individuals enrolled in those products. Please refer to Flexible Blue II or Individual Care Blue Plus or call 1-877-4MY-BLUE(469-2583) from 8 a.m. to 6 p.m. Monday through Friday for more information.
**Blue Cross Blue Shield of Michigan uses the DNoA Preferred Network for its dental plans. Dental Network of America is an independent company.
