How Dental Benefits Work
Delta Dental of Michigan administers Stryker's dental benefits. Under the Delta Dental program, you may choose any licensed dentist. If you choose a dentist who participates in Delta Dental Premier or Delta Dental PPO networks, you will pay only your copayment for covered services. Participating dentists agree to accept Delta Dental's payment and your copayment as payment in full for covered services.
If you choose a dentist who does not participate in a Delta Dental program, you will still be covered. However, you may have to pay more than just the copayment amount. You will also be responsible for the difference, if any, between Delta Dental's allowed fee and the dentist's submitted fee.
Your Deductible
A deductible is money you must spend on your own for covered services before the dental plan pays benefits. Your deductible is $50 per person per year, not to exceed $150 per family per year.
The deductible does not apply to Class I Benefits or to Class IV Benefits (see "Schedule of Benefits").
Before You Have Treatment
When you or a covered dependent expects to have any dental treatment that may cost more than $200, it is recommended that your dental provider submit a Pre-Treatment Estimate from Delta Dental. This lets you and the treating dentist know in advance what benefits are covered, how much the plan will pay and how much you will have to pay.
To file for pre-treatment estimate, ask your dentist to complete a claim form describing the planned services and charges, and submit the form to Delta Dental before treatment begins.
Optional Treatment
If you select a more expensive service than is customarily provided, Delta Dental may make an allowance for certain services based on the fee for the customarily provided service. You are responsible for the difference in cost. In all cases, Delta Dental will make the final determination regarding optional treatment and any available allowance.
While you are responsible for the difference in cost for any optional treatment, having a Pre-Treatment Estimate can help determine the amount you will have to pay toward the service before it is completed. Examples of services for which Delta Dental will provide an allowance for optional treatment include:
  • Overdentures – Delta Dental will pay only the amount that it would pay for a conventional denture.
  • Inlays, regardless of the material used – Delta Dental will pay only the amount that it would pay for an amalgam or composite resin restoration.
If You Lose Coverage During Treatment
If you or a covered dependent lose your dental coverage under Stryker's healthcare plan while receiving dental treatment, payment will be made only for those covered services actually received while coverage was in effect. However, crowns, jackets, bridges and dentures (full or partial) begun before the loss of eligibility will be covered if the work is completed within 60 days from the date coverage ends.