Federal Marketplace/Exchange

2021 Texas Dental Plans

Here are the plans available through the Federal Health Insurance Marketplace in your state

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Texas Dental Plan Comparison

We have several dental options for you and your family.
If you see a plan you like, you can then head to the Federal Marketplace to enroll.
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CHOICE HIGH CHOICE LOW ADVANTAGE ADVANTAGE LOW ADVANTAGE COPAY
Advantage Network Premier Network Out of Network Advantage Network Premier Network Out of Network Advantage Network Out of Network Advantage Network Out of Network Advantage Network Out of Network
Services
Preventive 100% 100% 100% up to MAC* 100% 100% 100% up to MAC* 100% 100% up to MAC* 100% 100% up to MAC* 100% 100%
Basic 80% 80% 80% up to MAC* 50% 50% 50% up to MAC* 50% 50% up to MAC* 50% 50% up to MAC* See CoPay Schedule See CoPay Schedule
Major 50% 50% 50% up to MAC* 50% 50% 50% up to MAC* 25% 25% up to MAC* 25% / Not Covered
(Children up to age 19** / Adults age 19 and older)
 25% up to MAC* / Not Covered
(Children up to age 19** / Adults age 19 and older)
Orthodontics
(Medically Necessary)
 50% 50% 50% 50% 50% 50% 50% 50% 50% / Discount Only
(Children up to age 19** / Adults age 19 and older)
 50% / Not Covered
(Children up to age 19** / Adults age 19 and older)
 50% 50%
Orthodontics
(Non-Medically Necessary)
 50% 50% 50% 50% 50% 50% Discount Only (Up to 25%) Not Covered Discount Only / Discount Only
(Children up to age 19** / Adults age 19 and older)
 Not Covered / Not Covered
(Children up to age 19** / Adults age 19 and older)
 50% 50%
Waiting Periods
Preventive None None None None None
Basic 6 Month Waiting Period 6 Month Waiting Period 6 Month Waiting Period 6 Month Waiting Period 6 Month Waiting Period
Major 15 Month Waiting Period 18 Month Waiting Period 12 Month Waiting Period None 12 Month Waiting Period
Orthodontics
(Medically Necessary / Non-Medically Necessary)
 None / 24 Month Waiting Period None / 24 Month Waiting Period None / Not Applicable None / Not Applicable None / 24 Month Waiting Period
Deductible (applies to Preventive, Basic and Major)
Individual $25 $100 $100 $75 $50
Family Max $75 $300 $300 $225 $150
Maximums
Major Annual Max $750 $500 $500 No Maximum No Maximum
Annual Max per Person $1,500 $1,500 $1,000 $1,000 No Maximum
Orthodontic Lifetime Max
(Medically Necessary / Non-Medically Necessary)
 No Maximum / $1,000 No Maximum / $1,000 No Maximum / Not Applicable No Maximum / Not Applicable No Maximum / $1,000
Pediatric EHB Annual Max No Maximum No Maximum No Maximum No Maximum / Not Applicable
(Children up to age 19** / Adults age 19 and older)
 No Maximum
Pediatric Individual EHB Out-of-Pocket Max
(up to age 19**)
 $350 $350 $350 $350 $350
Pediatric Family EHB Out-of-Pocket Max
(up to age 19**)
 $700 $700 $700 $700 $700
View Plan Details See Plan Details See Plan Details See Plan Details See Plan Details See Plan Details

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

These EMI Health dental plans have been reviewed and approved by the Texas Insurance Department. They meet all Federal regulations, fulfilling the requirements of the Affordable Care Act for individuals. General Policy Provisions