Georgia Dental Plan for 2020

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Premier PPO Low

Take advantage of more savings.

What is the Premier PPO Plan?

EMI Health's Premier PPO Plan offers a more expansive network, giving you more access to a wider range of providers. The Premier network gives you the peace of mind knowing that you shouldn't have any problems finding a provider that meets your needs at a cost that meets your budget. Search Premier network providers using our provider search here: Provider Search

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
50% 50% up to MAC*
Major
Crowns, Bridges, Prosthodontics
50% 50% up to MAC*
Orthodontics
(Medically Necessary / Non-Medically Necessary)
50% / Discount Only (Up to 25%) 50% / Not Covered
Specialists
Member Pays Same As General Dentist
Waiting Periods
Preventive None
Basic 6 Month Waiting Period
Major 18 Month Waiting Period
Orthodontics
(Medically Necessary / Non-Medically Necessary)
None / Not Applicable
Deductible
Individual $100
Family Max $300
Maximums
Major Annual Max $500
Annual Max per Person $1,000
Orthodontic Lifetime Max
(Medically Necessary / Non-Medically Necessary)
No Maximum / Not Applicable
Pediatric EHB Annual Max No Maximum
Pedriatric Individual EHB Out-of-Pocket Max $350
Pediatric Family EHB Out-of-Pocket Max $700

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 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, and Health, Inc.