Pennsylvania Advantage PPO Low for 2025
Take advantage of more savings
What is the Advantage PPO Low Plan?
EMI Health's Advantage 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).
| Children age up to 19** | Adults age 19 and older | |||
| Plan Summary | Advantage Plus Network | Out-of-Network | Advantage Network | Out-of-Network |
| Services | ||||
|
Preventive
Oral Exams, Cleanings, Sealants, X-rays, Fluoride
|
100% | 100% up to MAC* | 100% | 100% up to MAC* |
|
Basic
Fillings, Space Maintainers, Oral Surgery
|
50% | 50% up to MAC* | Not Covered | Not Covered |
|
Major
Crowns, Bridges, Prosthodontics, Endodontics, Periodontics
|
25% | 25% up to MAC* | Not Covered | Not Covered |
|
Orthodontics
(Medically Necessary / Non-Medically Necessary)
|
50% / Discount Only | 50% / Not Covered | Discount Only | Not Covered |
| Waiting Periods | ||||
| Preventive | None | |||
| Basic | None | |||
| Major | None | |||
|
Orthodontics
(Medically Necessary / Non-Medically Necessary)
|
None / Not Applicable | |||
| Deductible (applies to Preventive, Basic and Major) | ||||
| Individual | $50.00 | |||
| Family Max | $150.00 | |||
| Maximums | ||||
| Major Annual Max per person | 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 | Not Applicable | ||
| Pediatric Individual EHB Out-of-Pocket Max | $425 | Not Applicable | ||
| Pediatric Family EHB Out-of-Pocket Max | $850 | Not Applicable | ||
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.
**Through the last day of the month in which the Insured turns 19 years of age