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Utah Dental Plans for 2020

EMI Health is pleased to participate in Utah'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

CHOICE PPO HIGH CHOICE PPO ADVANTAGE PPO 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
Services
Preventive 100% 100% 100% up to MAC* 100% 100% 1000% up to MAC* 100% 100% up to MAC* 100% See Claim Payment Schedule
Basic 80% 80% 80% up to MAC* 80% 70% 70% up to MAC* 50% 50% up to MAC* See CoPay Schedule
Major 50% 50% 50% up to MAC* 50% 50% 50% up to MAC* 25% 25% up to MAC*
Orthodontics
Children (up to age 19)
50% 50% 50% Up to 25% Discount Up to 25% Discount No Coverage Up to 25% Discount No Coverage Up to 25% Discount No Coverage
All Members (Discount) Up to 25% Discount Up to 25% Discount No Discount Up to 25% Discount Up to 25% Discount No Discount Up to 25% Discount No Discount Up to 25% Discount No Discount
Specialists Member Pays Same As General Dentist Member Pays Same As General Dentist Member Pays Same As General Dentist 20% Discount (Pediatric: See Co-Pay Schedule) No Coverage
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 $50 $25 $50 $100 $50
Family Max $75 $150 $75 $150 $300 $150
Maximums
Major Annual Max $750 $500 $500 No Maximum
Annual Max per Person $1,500 $1,000 $1,500 $1,000 $1,000 No Maximum
Orthodontic Lifetime Max
(Medically Necessary / Non-Medically Necessary)
$1,000 No Coverage (Eligible for up to 25% Discount) Not Applicable Not Applicable
Pediatric EHB Annual Max No Maximum No Maximum No Maximum No Maximum
Pediatric 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.

These EMI Health dental plans have been reviewed and approved by the Utah Insurance Department. They meet all Federal regulations, fulfilling the requirements of the Affordable Care Act for individuals. General Policy Provisions