What is the Advantage Copay Plan?
EMI Health's Advantage Copay Plan is, as the name suggests, a copay plan. This means you have a fixed copay cost for covered dental services and procedures. You can know exactly how much a service or procedure will cost before you visit the dentist with the copay schedule.
The Advantage network gives you the opportunity to save with lower premiums and lower provider fees as a result of a more narrow network. Search Advantage network providers using our Provider Search.
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| Plan Summary | Advantage Network | Out-of-Network |
| Services | ||
|
Preventive
Oral Exams, Cleanings, Sealants, X-rays, Fluoride
|
100% | See Co-Pay Schedule |
|
Basic
Fillings, Space Maintainers, Oral Surgery
|
See Co-Pay Schedule | |
|
Major
Crowns, Bridges, Prosthodontics, Endodontics, Periodontics
|
||
|
Orthodontics (Up to age 19*)
|
50% | 50% |
| Waiting Periods | ||
| Preventive | None | |
| Basic (age 19 and older) | 6 Month Waiting Period | |
| Major (age 19 and older) | 12 Month Waiting Period | |
|
Orthodontics
(Medically Necessary / Non-Medically Necessary)
|
None / 24 Month Waiting Period | |
| Deductible (applies to Preventive, Basic and Major) | ||
| Individual | $50 | |
| Family Max | $150 | |
| Maximums | ||
| Major Annual Max (age 19 and older) | No Maximum | |
| Annual Max per Person (age 19 and older) | No Maximum | |
|
Orthodontic Lifetime Max
(Medically Necessary / Non-Medically Necessary)
|
No Maximum / $1,000 | |
| Pediatric EHB Annual Max | No Maximum | |
| Pedriatric Individual EHB Out-of-Pocket Max | $375 | |
| Pediatric Family EHB Out-of-Pocket Max | $750 | |
Benefits illustrated are in summary only. Refer to your Dental Policy for a complete description of benefits, limitations and exclusions.
All Services are subject to EMI Health Maximum Allowable Charge. When using a Non-participating Provider, the insured is responsible for all fees in excess of the Maximum Allowable Charge. Co-Pays/Claim Payments are subject to change January 1st of each year. Underwritten by Educators Health Plans Life, Accident and Health, Inc.
*Through the last day of the month in which the Insured turns 19 years of age