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Georgia Premier PPO Low for 2023

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What is the Premier PPO Plan?

EMI Health's Premier PPO Plan offers a more expansive network, giving you more access to a wider range of providers.
The Premier network gives you the peace of mind knowing that you shouldn't have any problems finding a provider that meets your needs at a cost that meets your budget. Search Premier network providers using our provider search here: Provider Search.
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Plan Summary Premier Network Out-of-Network
Services
Preventive
Oral Exams, Cleanings, Sealants, X-rays, Fluoride
100% 100% up to MAC*
Basic
Fillings, Space Maintainers, Oral Surgery
50% 50% up to MAC*
Major
Crowns, Bridges, Prosthodontics, Endodontics, Periodontics
50% 50% up to MAC*
Orthodontics (up to age 19**)
(Medically Necessary / Non-Medically Necessary)
50% / Discount Only 50% / Not Covered
Waiting Periods
Preventive None
Basic (age 19 and older) 6 Month Waiting Period
Major (age 19 and older) 18 Month Waiting Period
Orthodontics
(Medically Necessary / Non-Medically Necessary)
None / Not Applicable
Deductible (applies to Preventive, Basic and Major)
Individual $100
Family Max $300
Maximums
Major Annual Max (age 19 and older) $500
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
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 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