What is the Advantage PPO Plan?
EMI Health's Advantage PPO 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.
The Advantage network gives you the opportunity to save with lower premiums and lower provider fees as a result of a more narrow network. Search Advantage network providers using our Provider Search.
VISIT HEALTHCARE.GOV
VIEW AS PDF
| Plan Summary | Advantage 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
|
25% | 25% up to MAC* |
|
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) | None | |
| Major (age 19 and older) | 12 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 | $500 | |
| Annual Max per Person | $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 | $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 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