What is the Advantage PPO Low Plan?
EMI Health's Advantage PPO Low Plan is a coinsurance plan, which means we share your costs for covered dental services and procedures. Once you've met your deductible, we'll pay a percentage of your bill.
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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| Children age up to 19** | Adults age 19 and older | |||
| Plan Summary | Advantage Network | Out-of-Network | Advantage Network | Out-of-Network |
| Services | ||||
|
Preventive
Oral Exams, Cleanings, Sealants, X-rays, Fluoride
|
100% | 100% up to MAC* | 100% | 100% up to MAC* |
|
Basic
Fillings, Space Maintainers, Oral Surgery
|
50% | 50% up to MAC* | 50% | 50% up to MAC* |
|
Major
Crowns, Bridges, Prosthodontics, Endodontics, Periodontics
|
25% | 25% up to MAC* | Not Covered | Not Covered |
|
Orthodontics
(Medically Necessary / Non-Medically Necessary)
|
50% / Not Covered | 50% / Not Covered | Not Covered | Not Covered |
| Waiting Periods | ||||
| Preventive | None | |||
| Basic (age 19 and older) | 6 Month Waiting Period | |||
| Major | None | |||
|
Orthodontics
(Medically Necessary / Non-Medically Necessary)
|
None / Not Applicable | |||
| Deductible (applies to Preventive, Basic and Major) | ||||
| Individual | $75.00 | |||
| Family Max | $225.00 | |||
| Maximums | ||||
| Major Annual Max (age 19 and older) | No Maximum | |||
| Annual Max per Person (age 19 and older) | $1,000 | |||
|
Orthodontic Lifetime Max
(Medically Necessary / Non-Medically Necessary)
|
No Maximum / Not Applicable | |||
| Pediatric EHB Annual Max | No Maximum | Not Applicable | ||
| Pedriatric Individual EHB Out-of-Pocket Max | $375 | Not Applicable | ||
| Pediatric Family EHB Out-of-Pocket Max | $750 | Not Applicable | ||
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 Maximum Allowable Charge (MAC). When using a Non-participating Provider, the insured is responsible for all fees in excess of the Maximum Allowable Charge (MAC). 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