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Pennsylvania Choice PPO Low for 2023

The freedom of choice

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What is the Choice PPO Low Plan?

EMI Health's Choice PPO Low Plan is a rich dental benefit plan. This 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.
You can choose to visit dentists in different networks based on your needs. If you use the Advantage network, you'll see more savings. If your dentist isn't in the Advantage network, see if they are in the larger Premier network here: Provider Search.
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Plan Summary Advantage Network Premier Network Out-of-Network
Services
Preventive
Oral Exams, Cleanings, Sealants, X-rays, Fluoride
100% 100% 80% up to MAC*
Basic
Fillings, Space Maintainers, Oral Surgery
60% 60% 50% up to MAC*
Major
Crowns, Bridges, Prosthodontics, Endodontics, Periodontics
50% 40% 30% up to MAC*
Orthodontics (up to age 19**)
(Medically Necessary / Non-Medically Necessary)
50% / Discount Only 50% / Discount Only 50% / Not Covered
Waiting Periods
Preventive None
Basic None
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 per person (age 19 and older) $500
Annual Max per person (age 19 and older) $1,500 $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 $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.

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