SimpliveraCoverage Companion

Blue Dental PPO 100/50/50 (50/50/50)

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

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

Other cost-sharing reduction variants for this plan:

Standard High 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 EPO 80/50/50 (0/0/0)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$30
21$19
30$21
40$24
50$29
60$35
64 and over$38

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 ChildrenNo charge
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)No charge

Plan rules

Service area

This plan covers 1 geographic area.

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