Utah Dental Plan for 2020

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Choice PPO

The freedom of choice.

What is the Choice PPO Plan?

EMI Health's Choice PPO Plan is a rich dental benefit plan. This 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.

You can choose to visit dentists in different networks based on your needs. If you use the Advantage network, you'll see more savings. If your dentist isn't in the Advantage network, see if they are in the larger Premier network here: Provider Search

Plan Summary Advantage Network Premier Network Out-of-Network
Oral Exams, Cleanings, Sealants, X-rays, Fluoride
100% 100% 100% up to MAC*
Fillings, Space Maintainers, Oral Surgery
80% 70% 70% up to MAC*
Crowns, Bridges, Prosthodontics
50% 50% 50% up to MAC*
Children (up to age 19)
Up to 25% Discount Up to 25% Discount No Coverage
All Members (Discount)
Up to 25% Discount Up to 25% Discount No Discount
Member Pays Same As General Dentist
Waiting Periods
Preventive None
Basic 6 Month Waiting Period
Major 18 Month Waiting Period
Not Applicable
Individual $25 $50
Family Max $75 $150
Major Annual Max $500
Annual Max per Person $1,500 $1,000
Orthodontic Lifetime Max
(Medically / Non Medically Necessary)
No Coverage (Eligible for up to 25% Discount)
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, limitat ions 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.