Utah Advantage PPO for 2022
Take advantage of more savings
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
Children (age 7 through 18)
|
Up to 25% Discount | No Coverage |
|
All Members (Discount)
|
Up to 25% Discount | No Discount |
| Waiting Periods | ||
| Preventive | None | |
| Basic | 6 Month Waiting Period | |
| Major | 12 Month Waiting Period | |
|
Orthodontics
|
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
|
Not Applicable | |
| Pediatric EHB Annual Max | No Maximum | |
| Pedriatric Individual EHB Out-of-Pocket Max | $375 | |
| Pediatric Family EHB Out-of-Pocket Max | $750 | |
*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. Underwritten by Educators Health Plans Life, Accident, and Health, Inc.
†EHB Pediatric benefits do not apply to the annual maximum or major annual maximum