Michigan Dental Plans for 2021

EMI Health is pleased to participate in Michigan's Federal Health Insurance Marketplace for Individuals. We have been providing comprehensive insurance products and exemplary service since 1935. It is our mission to provide the best possible benefits for the lowest cost. By making EMI Health your choice for dental coverage, you get peace of mind knowing you have the best possible dental coverage. We have four plans to choose from, so you are sure to find one that best suits your needs. Enroll at HealthCare.gov

PREMIER PPO HIGH PREMIER PPO LOW ADVANTAGE PPO ADVANTAGE COPAY
Premier Network Out of Network Premier Network Out of Network Advantage Network Out of Network Advantage Network Out of Network
Services
Preventive 100% 100% up to MAC* 100% 80% up to MAC* 100% 100% up to MAC* 100% See CoPay Schedule
Basic 80% 80% up to MAC* 60% 50% up to MAC* 50% 50% up to MAC* See CoPay Schedule
Major 50% 50% up to MAC* 40% 30% up to MAC* 25% 25% up to MAC*
Orthodontics
(up to age 19**)
50% 50% Discount Only Not Covered Discount Only Not Covered Discount Only Not Covered
Orthodontics
(Adults)
Discount Only Not Covered Discount Only Not Covered Discount Only Not Covered Discount Only Not Covered
Waiting Periods
Preventive None None None None
Basic 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 12 Month Waiting Period
Orthodontics 24 Month Waiting Period Not Applicable Not Applicable Not Applicable
Deductible
Individual $25 $100 $100 $50
Family Max $75 $300 $300 $150
Deductible Applies To Preventive, Basic and Major Preventive, Basic and Major Preventive, Basic and Major Preventive, Basic and Major
Maximums
Major Annual Max $750 $500 $500 No Maximum
Annual Max per Person $1,000 $1,000 $1,000 No Maximum
Orthodontic Lifetime Max $1,000 Not Applicable Not Applicable Not Applicable
Pediatric EHB Annual Max No Maximum No Maximum No Maximum No Maximum
Petriatric Individual EHB Out-of-Pocket Max $350 $350 $350 $350
Pediatric Family EHB Out-of-Pocket Max $700 $700 $700 $700
View 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 Michigan Insurance Department. They meet all Federal regulations, fulfilling the requirements of the Affordable Care Act for individuals. General Policy Provisions