Tennessee Advantage Copay for 2024
Take advantage of more savings
What is the Advantage Copay Plan?
EMI Health's Advantage Copay Plan is, as the name suggests, a copay plan. This means you have a fixed copay cost for covered dental services and procedures. You can know exactly how much a service or procedure will cost before you visit the dentist with the copay schedule.
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| Plan Summary | Advantage Network | Out-of-Network |
| Services | ||
|
Preventive
Oral Exams, Cleanings, Sealants, X-rays, Fluoride
|
100% | See Co-Pay Schedule |
|
Basic
Fillings, Space Maintainers, Oral Surgery
|
See Co-Pay Schedule | |
|
Major
Crowns, Bridges, Prosthodontics, Endodontics, Periodontics
|
||
|
Orthodontics (Up to age 19*)
(Medically Necessary / Non-Medically Necessary)
|
50% / Discount Only | 50% / Not Covered |
| Waiting Periods | ||
| Preventive | None | |
| Basic (age 19 and older) | 6 Month Waiting Period | |
| Major (age 19 and older) | 12 Month Waiting Period | |
|
Orthodontics
(Medically Necessary / Non-Medically Necessary)
|
None / Not Applicable | |
| Deductible (applies to Preventive, Basic and Major) | ||
| Individual | $50 | |
| Family Max | $150 | |
| Maximums | ||
| Major Annual Max (age 19 and older) | No Maximum | |
| Annual Max per Person (age 19 and older) | No Maximum | |
|
Orthodontic Lifetime Max
(Medically Necessary / Non-Medically Necessary)
|
No Maximum / Not Applicable | |
| 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 Policy for a complete description of benefits, limitations and exclusions.
All Services are subject to EMI Health Maximum Allowable Charge. When using a Non-participating Provider, the insured is responsible for all fees in excess of the Maximum Allowable Charge. Co-Pays/Claim Payments are subject to change January 1st of each year. Underwritten by Educators Health Plans Life, Accident and Health, Inc.
*Through the last day of the month in which the Insured turns 19 years of age