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2016 Rates
Group Name:  AFGE
DeltaCare EPO     Group# 8116-0004 Delta Care EPO, which is similar to an HMO, treated only by dentist in the network
Delta Care Rates (which do NOT include your $13.00 union dues) are as follows:                
                         Single -              $16.00
                         Single + 1 -       $26.00
                         Family -             $35.00


Go to:  www.deltadentalmi.com to locate network dentist or click on the image below "Dental Office Toolkit" or or
Group Name:  AFGE
Delta Premiere    Group# 2116-0004
Delta Premiere - Allows you to go to any dentist
Delta Premiere Rates (which do NOT include your $13.00 union dues) are as follows:     
                       Single —        $22.00
                       Family—        $56.00
To Enroll:
      Contact Garland-Hill Agency
      Phone:  (313) 965-1777 or (866) 582-1777
      Fax: (313) 965-1696
      EMail: dental@garlandhill.com

Questions about Premium Payments:
     Contact Professional Benefit Administrators (PBA)
     1000 Hurricne Shoals Rd NE, Suite C-370, Lawrenceville, GA  30043
     Phone: (800) 578-2082
     Fax:  (770) 963-6126 or (888) 264-6975

To Withdraw:  
      We ask that you remain a member for at least 1 year before you
      are eligible for a withdrawal from any plan in order to keep our
      premium cost at a minimun.

      Members are asked to contact PBA to process withdrawals
    
For Benefit Information go to www.deltadentalmi.com
       Create a Username  & Password,
       Note when Registering, Your Member ID is your SSN
Click on the above image to link to the Consumer Toolkit to find out more about your benefits

Retirees:
Billed Quarterly in: March, June, September and December
2014 DeltaCare           
                       Single-             $ 31.44
                       Single + 1       $ 52.70
                       Family -           $ 73.24

2014 DeltaPremiere   
                       Single -            $ 44.55
                       Family-            $ 119.06




To enroll in Delta Premiere
Contact Garland-Hill Agency

(313) 965-1777 or (866) 582-1777

FAX ALL ENROLLMENT FORMS TO
Professional Benefits Administrators
(770) 963-6126 or (888) 264-6975
                              


                                      
BENEFIT DETAILS

Students & IRS Dependents may be included in the policy till age 25
 
With DeltaCare EPO Only - you have the freedom to visit any DeltaCare EPO dentist.
Their is no longer a requirement to choose a primary dental office location.  Referrals are not necessary to visit DeltaCare EPO specialists.
With Delta Premiere Only - Major oral surgery, periodontics, endodontics, major restorative, prosthetic and orthodontic services will not be covered until after a person is enrolled in the dental plan for 12 consecutive
months.
 
In the event that treatment is rendered from a dentist that does not participate in any of Delta Dental's programs, the patient may be responsible for more than the percentage indicated below.

(2016 Changes refkected in RED
               
                                                              DELTA PREMIER                DELTA CARE (EPO)


  Preventive - - - - - - - -                             100%                                  100%
  X-rays     - - - - - - - -                                100%                                  100%
  Bitewings X-Rays- - - - --                        100%                                  100%
  Basic   - - - - - - - - - - --                             65%
  Endodontics- - - - - - - -                             65%
  Periodontics- - - - - - - - -                          65%
  Oral Surgery  - - - - - - - -                          65%
  Simple Restorative- - - -                           65%
  Major Restorative - - - -                            50%
  Prosthetics - - - - - - -                                50%*
  Orthodontics    - - - - - -                            50%
  Ortho Age Limit- - - - - - -                        
26
 
* Benefit levels may vary for procedures that fall within this category. To determine the benefits
available for procedures performed or to be performed, submission of a pre-treatment estimate is
advised.

For some of the covered services,the patient may be required to satisfy a waiting period.
       
 
Participating Premier or Non Participating
Maximums
                                
Family Program Maximum      GENMAX0001     $
MAXIMUM REMOVED/year
Individual Program Maximum  GENMAX0001     $
1250.00/year
Individual Lifetime Maximum  ORTHOMAX0001 $
1250.00/year

 
* Maximum available and used apply to all services regardless of the dentist's participating status.
Routine Time Limitations: (Time limitations for other procedures may apply)  
   
Crowns: 1 per tooth in 60 months.     
Exams, cleanings and fluorides: 2 in 12 months; Fluoride up to age 19.     
Root planing and scaling: 1 per quadrant in 24 months; occlusal guard - 1 in a lifetime.     
Bitewings: 1 per 12 months.     
Full mouth x-rays: 1 per 60 months.     
Orthodontics: The age limitation is noted above.     
Bridges and dentures: 60 month replacement limit.     
Coordination of Benefits:     
Internal (within the same Delta group): Coordination of benefits is not allowed when the other member is covered within this group.     
External (with another Delta group or carrier): Coordination of benefits is allowed when the other member is covered within another dental plan.     
Every effort is made to provide accurate information. However, this is not a guarantee of payment.
If treatment will be rendered based on Delta Dental's payment liability, we recommend you predetermine your treatment plan.