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South Carolina Premier PPO High for 2024

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What is the Premier PPO High Dental Insurance Plan?

The Companion Life EMI Health Premier PPO High Dental Insurance 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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Plan Summary Premier Network Out-of-Network
Services
Preventive
Oral Exams, Cleanings, Sealants, X-rays, Fluoride
100% 100% up to MAC*
Basic
Fillings, Space Maintainers, Oral Surgery
80% 80% up to MAC*
Major
Crowns, Bridges, Prosthodontics, Endodontics, Periodontics
50% 50% up to MAC*
Orthodontics (Up to age 19*)
(Medically Necessary / Non-Medically Necessary)
50% / 50% 50% / 50%
Waiting Periods
Preventive None
Basic (age 19 and older) 6 Month Waiting Period
Major (age 19 and older) 15 Month Waiting Period
Orthodontics
(Medically Necessary / Non-Medically Necessary)
None / 24 Month Waiting Period
Deductible (applies to Preventive, Basic and Major)
Individual $25
Family Max $75
Maximums
Major Annual Max (age 19 and older) $750
Annual Max per Person (age 19 and older) $1,000
Orthodontic Lifetime Max
(Medically Necessary / Non-Medically Necessary)
No Maximum / $1000
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 Insurance 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 Companion Life Insurance Company.

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