What is the Premier PPO Dental Insurance Plan?
The Companion Life EMI Health Premier PPO 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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| Children age up to 19** | Adults age 19 and older | |||
| Plan Summary | Dentemax Network | Out-of-Network | Dentemax Network | Out-of-Network |
| Services | ||||
|
Preventive
Oral Exams, Cleanings, X-rays, Fluoride, Sealants, Space Maintainers
|
100% | 100% up to MAC* | 100% | 100% up to MAC* |
|
Basic
Fillings
|
50% after deductible | 50% after deductible up to MAC* | 50% after deductible | 50% after deductible up to MAC* |
|
Major
Crowns, Bridges, Prosthodontics
|
50% after deductible | 50% after deductible up to MAC* | Not Covered | Not Covered |
|
Orthodontics
Medically Necessary Orthodontics Only
|
50% | 50% | Not Covered | Not Covered |
| Waiting Periods | ||||
| Preventive | None | |||
| Basic (age 19 and older) | 6 Month Waiting Period | |||
| Major | None | |||
|
Orthodontics
|
None | |||
| Deductible | ||||
| Individual | $75.00 | |||
| Family Max | $225.00 | |||
| Deductible Applies To | Type 2 & Type 3 | |||
| Maximums | ||||
| Annual Max per Person (age 19 and older) | $1,000 | |||
|
Orthodontic Lifetime Max
|
No Maximum | |||
| Pediatric EHB Annual Max | No Maximum | |||
| Pediatric 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 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 Companion Life Insurance Company.
**Through the last day of the month in which the Insured turns 19 years of age