What is the Premier PPO Low Plan?
EMI Health's Premier 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.
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Language Assistance
If you, or someone you’re helping, has questions about the EMI Health Policy, you have the right to get help and information in your language at no cost. To talk to an interpreter, call 800-662-5851 (TTY: 1-888-236-4823).
| Plan Summary | Premier Network | Out-of-Network |
| Services | ||
|
Preventive
Oral Exams, Cleanings, Sealants, X-rays, Fluoride
|
100% | 80% up to MAC* |
|
Basic
Fillings, Space Maintainers, Oral Surgery
|
60% | 50% up to MAC* |
|
Major
Crowns, Bridges, Prosthodontics, Endodontics, Periodontics
|
40% | 30% up to MAC* |
|
Orthodontics (Children age 7 through 18)
|
Discount Only | Not Covered |
|
Orthodontics (Adults)
|
Discount Only | 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
|
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
|
Not Applicable | |
| Pediatric EHB Annual Max | No Maximum | |
| Pedriatric Individual EHB Out-of-Pocket Max | $425 | |
| Pediatric Family EHB Out-of-Pocket Max | $850 | |
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.