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
|
80% | 80% up to MAC* |
|
Major
Crowns, Bridges, Prosthodontics, Endodontics, Periodontics
|
50% | 50% up to MAC* |
|
Orthodontics (Children age 7 through 18)
|
50% | 50% |
|
Orthodontics (Adults)
|
Discount Only | Not Covered |
| Waiting Periods | ||
| Preventive | None | |
| Basic (age 19 and older) | 6 Month Waiting Period | |
| Major (age 19 and older) | 15 Month Waiting Period | |
|
Orthodontics
|
24 Month Waiting Period† | |
| Deductible (applies to Preventive, Basic and Major) | ||
| Individual | $25 | |
| Family Max | $75 | |
| Maximums | ||
| Major Annual Max (age 19 and older) | $750 | |
| Annual Max per Person (age 19 and older) | $1,000 | |
|
Orthodontic Lifetime Max
|
$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 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.
†24 month waiting period does not apply to medically necessary orthodontics.