Texas Dental Plans for 2021

Preferred Language

EMI Health is pleased to participate in Texas'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 five plans to choose from, so you are sure to find one that best suits your needs. Enroll at HealthCare.gov

	CHOICE HIGH			CHOICE LOW			ADVANTAGE		ADVANTAGE LOW		ADVANTAGE COPAY
	Advantage Network	Premier Network	Out of Network	Advantage Network	Premier Network	Out of Network	Advantage Network	Out of Network	Advantage Network	Out of Network	Advantage Network	Out of Network
Services
Preventive	100%	100%	100% up to MAC*	100%	100%	100% up to MAC*	100%	100% up to MAC*	100%	100% up to MAC*	100%	100%
Basic	80%	80%	80% up to MAC*	50%	50%	50% up to MAC*	50%	50% up to MAC*	50%	50% up to MAC*	See CoPay Schedule	See CoPay Schedule
Major	50%	50%	50% up to MAC*	50%	50%	50% up to MAC*	25%	25% up to MAC*	25% / Not Covered (Children up to age 19** / Adults age 19 and older)	25% up to MAC* / Not Covered (Children up to age 19** / Adults age 19 and older)	See CoPay Schedule	See CoPay Schedule
Orthodontics (Medically Necessary)	50%	50%	50%	50%	50%	50%	50%	50%	50% / Discount Only (Children up to age 19** / Adults age 19 and older)	50% / Not Covered (Children up to age 19** / Adults age 19 and older)	50%	50%
Orthodontics (Non-Medically Necessary)	50%	50%	50%	50%	50%	50%	Discount Only (Up to 25%)	Not Covered	Discount Only / Discount Only (Children up to age 19** / Adults age 19 and older)	Not Covered / Not Covered (Children up to age 19** / Adults age 19 and older)	50%	50%
Waiting Periods
Preventive	None			None			None		None		None
Basic	6 Month Waiting Period			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		None		12 Month Waiting Period
Orthodontics (Medically Necessary / Non-Medically Necessary)	None / 24 Month Waiting Period			None / 24 Month Waiting Period			None / Not Applicable		None / Not Applicable		None / 24 Month Waiting Period
Deductible
Individual	$25			$100			$100		$75		$50
Family Max	$75			$300			$300		$225		$150
Deductible Applies To	Preventive, Basic and Major			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		No Maximum
Annual Max per Person	$1,500			$1,500			$1,000		$1,000		No Maximum
Orthodontic Lifetime Max (Medically Necessary / Non-Medically Necessary)	No Maximum / $1,000			No Maximum / $1,000			No Maximum / Not Applicable		No Maximum / Not Applicable		No Maximum / $1,000
Pediatric EHB Annual Max	No Maximum			No Maximum			No Maximum		No Maximum / Not Applicable (Children up to age 19** / Adults age 19 and older)		No Maximum
Pediatric Individual EHB Out-of-Pocket Max (up to age 19**)	$350			$350			$350		$350		$350
Pediatric Family EHB Out-of-Pocket Max (up to age 19**)	$700			$700			$700		$700		$700
View Plan Details	See 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 Texas Insurance Department. They meet all Federal regulations, fulfilling the requirements of the Affordable Care Act for individuals. General Policy Provisions