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North Carolina Premier PPO Low for 2025

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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 (Up to age 19**)
(Medically Necessary / Non-Medically Necessary)
 50% / Not Covered 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 $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 EMI Health 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 & Health, Inc.

EMI Health Association does not discriminate on the basis of basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

**Through the last day of the month in which the Insured turns 19 years of age

NOTICE: Your actual expenses for covered services may exceed the stated coinsurance percentage because actual provider charges may not be used to determine plan and member payment obligations.