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 Claim Payment Schedule |
|
Basic
Fillings, Space Maintainers, Oral Surgery
|
See Co-Pay Schedule | |
|
Major
Crowns, Bridges, Prosthodontics, Endodontics, Periodontics
|
||
|
Orthodontics
Children (age 7 through 18)
|
Discount Only | No Coverage |
|
Adults
|
Discount Only | No Coverage |
|
Specialists (** See note below)
|
See Co-Pay Schedule | See Claim Payment Schedule |
| **All of the benefits outlined above are for services received from general and pediatric dentists. If participating specialists (including, but not limited to, oral surgeons, endodontists, periodontists, and prosthodontists) are used, insureds receive a discount only. There is no benefit for non-participating specialists. | ||
| Waiting Periods | ||
| Preventive | None | |
| Basic | 6 Month Waiting Period | |
| Major | 12 Month Waiting Period | |
|
Orthodontics
|
Not Applicable | |
| Deductible (applies to Preventive, Basic and Major) | ||
| Individual | $50 | |
| Family Max | $150 | |
| Maximums | ||
| Major Annual Max | No Maximum | |
| Annual Max per Person | No Maximum | |
|
Orthodontic Lifetime Max
|
Not Applicable | |
| Pediatric EHB Annual Max | None | |
| Pedriatric Individual EHB Out-of-Pocket Max | $375 | |
| Pediatric Family EHB Out-of-Pocket Max | $750 | |
Co-Pays/Claim Payments are subject to change January 1st of each year. 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.