MDA Health Plan

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MDA Insurance Programs

Required forms

To obtain a quote, both the Census form and the Participation and Business Rules document must be submitted to us. Please be sure to download and complete them both and return them to us. Additionally, each employee who wishes to be quoted must complete and submit a Health Plan Questionnaire, below.

Census Form to obtain a quote. Please follow the directions on the cover page and submit the completed census and the Participation and Business Rules document to MDA Insurance via fax at 517.484.5460.
Participation and Business Rules document. You will also need this form to obtain a quote.
Health Plan Questionnaire. Each employee, including the employer, who wishes to be quoted for benefits must complete and return this document.

Change of Status Form for address or name changes, adding a newborn, deleting dependents or terminating coverage for active subscribers.

New Hire / Enrollment Package to enroll employees in practices offering one MDA Health Plan option.

Waiver of Coverage Form to document that an employee opts to waive participation in your group health plan.

Tax-Advantaged Premium Payment Plans

The monthly invoice for your office’s participation in the MDA Health Plan must be paid by the employer only. Employers may payroll-deduct their employees’ share of the cost of the health plan. By offering a Premium Only Plan (POP), employees can make their contribution on a pre-tax basis, reducing their taxable income and reducing your practice’s payroll taxes.

A POP can be established using Alerus, which the MDA endorses for pre-tax benefits and integrated payroll services. For information on establishing a POP for your practice, click here or call Alerus at 303-481-1577.

Priority Health Links

The MDA Health Plan is powered by Priority Health and uses the Priority Health provider networks. Prioirty Health brings many new services to our subscribers. Click the links below to learn more.

Find a Provider Using the Priority Health Network Map: Use this to search for your providers. The network names are hyperlinks to search sites.
Complete Approved Drug Formulary:For MDA Health Plan members
Prescription Drug Prior Authorization Form: For step-therapy drugs, call Priority Health at 800-956-1954.
Approved HSA Preventative Drug List*: Paid prior to deductible for high-deductible health plan subscribers (Plan 6). For drug coverage call Priority Health at 800-956-1954.
Medical Case Management: For help with chronic conditions and serious illnesses
Assist America Global Emergency Service (PDF): Travel and medical assistance when 100 miles or more from home. Learn about Assist America (member log-in required)
Virtual Visits: Get care for minor illnesses virtually (member log-in required)!
Health Care Blue Book (PDF): Learn the cost of care before you obtain it (member log-in required)
Access to Discounted Products and Services: Save on gym memberships, computers, water treatment systems and more (member log-in required)
Member Account Online: Create your personal Priority Health portal
Using Your Mobile Account: Smartphone app access to your health plan account (member log-in required)
HSA Frequently Asked Questions: Info you need to know
Preventive Care Guidelines: To help you know what preventive care is available and why to take advantage of it log into your member portal.

*Note that prescription drug formularies are subject to change at any time.

MDA Health Plan for Dental Offices

Understanding the MDA Health Plan

The MDA Health Plan is available exclusively to members of the Michigan Dental Association and their employees. This is an employer-sponsored group health plan organized as a self-insured multiple employer welfare arrangement (MEWA). The dentist, as the employer, sets the eligibility rules for employees to participate in the MDA Health Plan. Transparency in health care costs>

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Each employer retains the right to determine:

How many hours per week an employee must work to be eligible for the plan, with a minimum requirement of 24 hours per week*.
Whether to include the employee’s spouse and/or child(ren) in the plan.
Whether to contribute toward the cost of the health plan on their employees’ behalf. Contributions may be a percentage of the cost or a flat dollar amount. Employers may contribute to employee-only coverage, or to the cost of spouse/dependent coverage.

Employers may not discriminate in providing coverage or in contribution levels.

*Employers of 50 or more full-time equivalent employees must allow participation at 30 hours of work per week, in accordance with the Affordable Care Act.

Rates will be developed based on the census of the office.

There are 4 geographic rating areas
Each subscriber on the policy has his/her own rate by age in 5-year age bands
Each child under 19 has his/her own rate, up to a maximum of 3 children per family
Rates are added together to produce an aggregate for the office

Enrollment additions and deletions

To ensure proper coverage and billing, please be sure to report enrollment changes such as new eligible employees, newborns, divorces and employee terminations to us immediately. Please use the Enrollment Change Form, available at left, to submit new subscribers or delete employees who are no longer eligible or who leave your employment. Changes must be reported within 30 days.

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Important update regarding Michigan Auto Insurance No-Fault changes

The new Michigan No-Fault law took effect July 2, 2020, and impacts every Michigan driver. It’s critical you understand what the changes mean to you and your auto insurance policy. Consider enrollment in the MDA Health Plan, where the plan is the primary coverage in an auto accident, providing you with an added layer of protection. If you have questions or wish to discuss options, call MDA Insurance at (800) 860-2272 and speak with one of our personal lines agents as soon as possible.

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Plan Designs

Download the 2023 plan overview guide

Tips for understanding your plan: Deductibles, copays and coinsurance >>

In the chart below, the SBC is the Summary of Benefits and Coverage. The BAAG is the plan’s Benefits-at-a-Glance. Click on the acronyms to download the PDF and view the information.

2023 Preferred Provider Organization (PPO) Plans

In-Network Amounts
Plan Name	Deductible	Co-Pay	Total Out-of-Pocket
Simply Copay PPO (Plan 0) SBC BAAG	$0 Single/ $0 Two-Person/ $0 Family Prescriptions: $10 generic/ $20 non-preferred generic / 50% preferred ($100 max)/ 50% non-preferred ($300 max) / 20% preferred specialty ($200 max) / 50% non-preferred specialty ($500 max)	$0 Office Visit $75 Specialist $75 Urgent Care $500 E.R. (waived if admitted)	$8,700 / $13,875 / $17,400
Living Fit PPO (Plan 11) SBC BAAG	$3,000 Single/ $4,500 Two-Person/ $6,000 Family Prescriptions: $10 generic/ $20 non-preferred generic / 50% preferred ($100 max)/ 50% non-preferred ($300 max) / 20% preferred specialty ($200 max) / 50% non-preferred specialty ($500 max); LEARN MORE >	$30 Office Visit $45 Specialist $50 Urgent Care $100 E.R. 20% coinsurance	$8,700 / $13,875 / $17,400
Premier Elite PPO (Plan 1) SBC BAAG	$500 Single/ $1,000 Two-Person/ $1,500 Family Prescriptions: $10 generic/ $20 non-preferred generic / $50 preferred brand/ $100 non-preferred brand / 20% preferred specialty ($200 max) / 50% non-preferred specialty ($500 max)	$30 Office Visit $60 Specialist $35 Urgent Care $100 E.R. 20% coinsurance	$8,700/ $13,875/$17,400
Elite PPO (Plan 2) SBC BAAG	$1,000 Single/ $2,000 Two-Person/ $3,000 Family Prescriptions: $10 generic/ $20 non-preferred generic / $50 preferred brand/ $100 non-preferred brand / 20% preferred specialty ($200 max) / 50% non-preferred specialty ($500 max)	$30 Office Visit $45 Specialist $35 Urgent Care $100 E.R. 20% coinsurance	$8,700/ $13,875/$17,400
Select PPO (Plan 3) SBC BAAG	$1,500 Single/ $3,000 Two-Person/ $4,500 Family Prescriptions: $10 generic/ $20 non-preferred generic / $60 preferred brand/ $120 non-preferred brand / 20% preferred specialty ($200 max) / 50% non-preferred specialty ($500 max)	$35 Office Visit $70 Specialist $35 Urgent Care $100 E. R. 20% coinsurance	$8,700/ $13,875/$17,400
Classic Plus PPO (Plan 4) SBC BAAG	$2,500 Single/ $5,000 Two-Person/ $7,500 Family Prescriptions: $10 generic/ $20 non-preferred generic / $60 preferred brand/ $120 non-preferred brand / 20% preferred specialty ($200 max) / 50% non-preferred specialty ($500 max)	$35 Office Visit $55 Specialist $35 Urgent Care $100 E. R. 20% coinsurance	$8,700/ $13,875/$17,400
Family Focus PPO (Plan 8) SBC BAAG	$3,000 Single/ $4,500 Two-Person/ $4,500 Family Prescriptions: $10 generic/ $20 non-preferred generic / $60 preferred brand/ $120 non-preferred brand / 20% preferred specialty ($200 max) / 50% non-preferred specialty ($500 max)	$20 Office Visit $40 Specialist $50 Urgent Care $100 E. R. 20% coinsurance	$8,700/ $17,400/$17,400
Advanced Value (Plan 10) SBC BAAG	$7,150 Single/ $12,500 Two-Person/ $14,300 Family Prescriptions: $10 generic / $20 non-preferred generic / 50% preferred brand (max $100) / 50% non-preferred brand (max $300) / 20% preferred specialty ($200 max) / 50% non-preferred specialty ($500 max)	$35 Office Visit $70 Specialist $100 E.R. $50 Urgent Care	$8,700/ $13,875/$17,400

The plans below are qualified for health savings accounts (HSA). Fund your HSA with pre-tax dollars to reduce your taxable income and pay for eligible medical and vision expenses. Unexpended funds accrue from year to year and can be used to pay for health care in retirement.

2023 High-Deductible/HSA Health Plans

In-Network Amounts
Plan Name	Deductible	Co-Pay	Total Out-of-Pocket
Living Fit HSA (Plan 12) SBC BAAG	$3,000 Single $6,000 family	20% coinsurance Prescriptions: $10 generic/ $20 non-preferred generic / $60 preferred brand/ $120 non-preferred brand / 20% preferred specialty ($200 max) / 50% non-preferred specialty ($500 max); LEARN MORE >	$7,050 Single $14,100 Two-Person $14,100 Family
Elite HSA (Plan 5) SBC BAAG	$2,000 Single $4,000 family	20% coinsurance Prescriptions: $10 generic/ $20 non-preferred generic / $60 preferred brand/ $120 non-preferred brand / 20% preferred specialty ($200 max) / 50% non-preferred specialty ($500 max)	$7,050 Single $14,100 Two-Person $14,100 Family
Family Focus HSA (Plan 6) SBC BAAG	$3,000 Single $6,000 family	20% coinsurance Prescriptions: $10 generic/ $20 non-preferred generic / $60 preferred brand/ $120 non-preferred brand / 20% preferred specialty ($200 max) / 50% non-preferred specialty ($500 max)	$7,050 Single $14,100 Two-Person $14,100 Family

Living Fit Health Plan: LEARN MORE >

Family Focus Health Plan: LEARN MORE >

CLICK HERE FOR Frequently Asked Questions guide about Health Savings Accounts.

MDA Insurance does not endorse any financial institution for Health Savings Accounts.

All MDA Health Plan designs are powered by Priority Health. Participating providers and facilities are part of the multi-tier networks used by Priority Health. Claims are administered on behalf of the MDA Health Plan by Priority Health. MDA Insurance can provide assistance with any claim questions or subscriber service needs.

Subscriber Service Contact Information:
MDA Insurance: 877.906.9924 Mon.- Fri. 8 a.m. – 5 p.m.
Priority Health: 800.956.1954 Mon. – Thurs. 7:30 a.m. – 7 p.m.; Fri. 9 a.m. to 5 p.m., Sat. 8:30 a.m. to 12 Noon

Prescription Drug Benefits*

Click here for extensive information on MDA Health Plan prescription drug benefits.
*Note that prescription drug formularies are subject to change at any time.

Plan Documents

Various regulations require the documents below to be made available to MDA Health Plan sponsors and employees. Documents may be downloaded and saved or printed. Adobe Acrobat Reader is required to access these documents. You may access a free download of Acrobat Reader by clicking here.

PPO Plans

Schedule of Medical Benefits:

High-deductible Health Plans (HSA)

Schedule of Medical Benefits:

Want Vision Insurance?

MDA Insurance offers your choice of insured vision plans on a stand-alone basis. Plans are billed quarterly on an individual basis. For information on vision insurance plans and rates, please click here.

Employer Financial Obligation Notice

The members who participate in the self-insured MDA Health Plan ultimately are responsible for paying claims. The state of Michigan requires language to be included in the participation agreement that states members understand they could be assessed up to four months of contributions to cover shortfalls if necessary.

If the employer ceases to participate in the MDA Health Plan, it continues to be liable to the health plan trust for its proportionate share of any assessment made by the Michigan Insurance Commission for benefits paid during the previous calendar year.
If the cash reserves of the Trust and Plan are less than required by Michigan, participating employers will be liable for up to four months of contingent premiums should the plan’s Trustees demand it during the time the employer participates in the plan and for the one-year period after participation in the plan terminates.
While this possibility exists, it is remote. The MDA Health Plan is using an actuary to project claims based on historic and anticipated utilization. The state of Michigan reviews and actuarial analysis for reasonableness and accuracy. These actuarial projects of plan expenses are used to build the rates to provide adequate contributions from members.
Another factor that makes it unlikely that an assessment would be required is MDA Insurance’s 30-plus years of successfully administering its individual health plan, which required the negotiation of rates to ensure the adequate collection of funds to cover claims.

Need assistance? Call MDA Insurance at 877-906-9924, then, based on the first letter of your practice name, enter the extension number of the staff below: