Nevada Advantage Copay for 2021
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Compare All Dental Plans Advantage Copay Copayment Schedule (PDF)
What is the Advantage Copay Plan?
Plan Summary | Advantage Network | Out-of-Network |
Services | ||
Preventive
Oral Exams, Cleanings, Sealants, X-rays, Fluoride
|
100% | See Co-Pay Schedule* |
Basic
Fillings, Space Maintainers, Oral Surgery
|
See Co-Pay Schedule* | |
Major
Crowns, Bridges, Prosthodontics, Endodontics, Periodontics
|
||
Orthodontics (up to age 19**)
(Medically Necessary / Non-Medically Necessary)
|
50% / Discount Only (Up to 25%) | 50% / Not Covered |
Waiting Periods | ||
Preventive | None | |
Basic (age 19 and older) | 6 Month Waiting Period | |
Major (age 19 and older) | 12 Month Waiting Period | |
Orthodontics
(Medically Necessary / Non-Medically Necessary)
|
None / Not Applicable | |
Deductible (applies to Basic and Major) | ||
Individual | $100 | |
Family Max | $300 | |
Maximums | ||
Major Annual Max | No Maximum | |
Annual Max per Person | No Maximum | |
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 | $350 | |
Pediatric Family EHB Out-of-Pocket Max | $700 |
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. When using a Non-participating Provider, the insured is responsible for all fees in excess of the Maximum Allowable Charge. Co-Pays/Claim Payments are subject to change January 1st of each year. 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