Wisconsin Advantage Copay for 2024
Take advantage of more savings
What is the Advantage Copay Dental Insurance Plan?
The Companion EMI Health Advantage Copay Dental Insurance 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 Co-Pay Schedule |
|
Basic
Fillings, Space Maintainers
|
See Co-Pay Schedule | |
|
Major
Crowns, Bridges, Prosthodontics
|
||
|
Orthodontics (up to age 19*)
(Medically Necessary) |
50% | 50% |
|
Orthodontics (up to age 19*)
(Non-Medically Necessary) |
Discount Only | Not Covered |
| Waiting Periods | ||
| Preventive | None | |
| Basic (age 19 and older) | 6 Month Waiting Period | |
| Major (age 19 and older) | 12 Month Waiting Period | |
|
Orthodontics
(Medically Necessary) |
None | |
|
Orthodontics
(Non-Medically Necessary) |
Not Applicable | |
| Deductible (applies To Preventive, Basic and Major) | ||
| Individual | $50.00 | |
| Family Max | $150.00 | |
| Maximums | ||
| Major Annual Max | No Maximum | |
| Annual Max per Person | No Maximum | |
|
Orthodontic Lifetime Max
(Medically Necessary) |
Not Maximum | |
|
Orthodontic Lifetime Max
(Non-Medically Necessary) |
Not Applicable | |
| Pediatric EHB Annual Max | No Maximum | |
| Pedriatric Individual EHB Out-of-Pocket Max | $375 | |
| Pediatric Family EHB Out-of-Pocket Max | $750 | |
Benefits illustrated are in summary only. Refer to your Dental Insurance Policy for a complete description of benefits, limitations and exclusions.
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. Co-Pays/Claim Payments are subject to change January 1st of each year. Underwritten by Companion Life Insurance Company.
*Through the last day of the month in which the Insured turns 19 years of age