2021 Utah Pediatric Dental Plans
Here are the plans available through the Federal Health Insurance Marketplace in your state
Utah EHB Pediatric Advantage & Premier Comparison
| Plan Summary | EHB Pediatric | EHB Pediatric |
|
Network
|
Advantage Network Only | Premier Network Only |
|
Routine cleanings, exams, fluoride, x-rays and sealants
|
70% | 70% |
|
Out of Pocket Max
|
$350 Individual / $700 Family | $350 Individual / $700 Family |
|
Pediatric Annual Maximum
|
No Maximum | No Maximum |
|
Oral Examinations
|
Periodic oral exam fees are allowed twice in a plan year. A re-evaluation is considered included in the primary procedure and is not payable separately. | Periodic oral exam fees are allowed twice in a plan year. A re-evaluation is considered included in the primary procedure and is not payable separately. |
|
Diagnostic x-rays/services
|
Complete mouth x-rays (posterior bitewing films and 14 periapical films plus bitewings) are allowed once during any three-year period for members age 13 through the last day of the month in which the Insured turns 19 years of age, in lieu of panorex x-ray. Full series bitewing x-rays (4) are allowed only twice in a plan year. A panorex is allowable once during any three-year period in lieu of complete mouth x-ray. Vertical bitewings are payable up to eight films. |
Complete mouth x-rays (posterior bitewing films and 14 periapical films plus bitewings) are allowed once during any three-year period for members age 13 through the last day of the month in which the Insured turns 19 years of age, in lieu of panorex x-ray. Full series bitewing x-rays (4) are allowed only twice in a plan year. A panorex is allowable once during any three-year period in lieu of complete mouth x-ray. Vertical bitewings are payable up to eight films. |
|
Preventive
|
Prophylaxis (cleaning) is allowed twice in a plan year. A child Prophylaxis will be allowed through age 13. An adult Prophylaxis will be allowed for age 14 through the last day of the month in which the Insured turns 19 years of age. Application of fluoride in conjunction with cleaning, 2 times in a plan year. Sealants on permanent molars are allowed once during any five-year period. Permanent molars include teeth numbers 1, 2, 3, 14, 15, 16, 17, 18, 19, 30, 31, and 32. (Permanent molars with occlusal restoration are ineligible.) |
Prophylaxis (cleaning) is allowed twice in a plan year. A child Prophylaxis will be allowed through age 13. An adult Prophylaxis will be allowed for age 14 through the last day of the month in which the Insured turns 19 years of age. Application of fluoride in conjunction with cleaning, 2 times in a plan year. Sealants on permanent molars are allowed once during any five-year period. Permanent molars include teeth numbers 1, 2, 3, 14, 15, 16, 17, 18, 19, 30, 31, and 32. (Permanent molars with occlusal restoration are ineligible.) |
| View 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). Unless otherwise noted, coverage is effective through the last day of the month in which the insured turns 19 years of age. Underwritten by Educators Health Plans Life, Accident, and Health, Inc.
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