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>
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.
Download EaseCentral Online Administration Registration Form REGISTER NOW ›
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.
Plan Designs
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:
- Simply Copays PPO (Plan 0)
- Premier Elite PPO (Plan 1)
- Elite PPO (Plan 2)
- Select PPO (Plan 3)
- Classic Plus PPO (Plan 4)
- Family Focus PPO (Plan 8)
- Advanced Value (Plan 10)
- Summary Plan Description for Plans 1-4, 8, and 10
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:
