SimpliveraCoverage Companion

Blue Dental EPO 80/50/50 (0/0/0)

Blue Cross Blue Shield of Michigan Mutual Insurance Company · 2026 plan year

Low
Ind. deductible
$25
Family deductible
$75
Ind. OOP max
$450
Family OOP max
$900

Other cost-sharing reduction variants for this plan:

Standard Low Off Exchange Plan

More Blue Cross Blue Shield of Michigan Mutual Insurance Company plans in MI

Blue Dental PPO 100/70/50 (80/60/50)Blue Dental PPO 100/50/50 (50/50/50)Blue Dental PPO Plus 80/60/50Blue Dental PPO 80/50/50 (50/50/50)Blue Dental PPO Pediatric 80/50/50 (50/50/50)

Monthly premiums by age

Rating Area 9 — the lowest-priced of the 16 areas this plan covers. Premiums differ by area.

AgeIndividual
Under 15$25
21$13
30$15
40$17
50$20
60$24
64 and over$26

Live premium estimate

$

Benefits & cost sharing

Other

BenefitIn-network
Accidental Dental50.00% Coinsurance after deductible
Basic Dental Care - Adult50.00% Coinsurance after deductible
Basic Dental Care - Child50.00% Coinsurance after deductible
Dental Check-Up for Children20.00%
Major Dental Care - Adult50.00% Coinsurance after deductible
Major Dental Care - Child50.00% Coinsurance after deductible
Orthodontia - AdultNot covered
Orthodontia - ChildNot covered
Routine Dental Services (Adult)20.00%

Plan rules

Service area

This plan covers 82 geographic areas.

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