2024 Wisconsin Dental Insurance Plans
Here are the plans available through the Federal Health Insurance Marketplace in your state
Wisconsin Dental Insurance Plan Comparison
| Premier PPO HIGH | Premier PPO LOW | ADVANTAGE PPO | ADVANTAGE COPAY | |||||
| Premier Network | Out of Network | Premier Network | Out of Network | Advantage Plus Network | Out of Network | Advantage Network | Out of Network | |
| Services | ||||||||
| Preventive | 100% | 100% up to MAC* | 100% | 80% up to MAC* | 100% | 100% up to MAC* | 100% | See CoPay Schedule |
| Basic | 80% | 80% up to MAC* | 60% | 50% up to MAC* | 50% | 50% up to MAC* | See CoPay Schedule | |
| Major | 50% | 50% up to MAC* | 40% | 30% up to MAC* | 25% | 25% up to MAC* | ||
|
Orthodontics (Up to age 19**) (Medically Necessary)
|
50% | 50% | 50% | 50% | 50% | 50% | 50% | 50% |
|
Orthodontics (Up to age 19**) (Non-Medically Necessary)
|
50% | 50% | Discount Only | Not Covered | Discount Only | Not Covered | Discount Only | Not Covered |
| 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 (Medically Necessary / Non-Medically Necessary)
|
None / 24 Month Waiting Period | None / Not Applicable | None / Not Applicable | None / Not Applicable | ||||
| Deductible (applies to Preventive, Basic and Major) | ||||||||
| Individual | $25 | $100 | $100 | $50 | ||||
| Family Max | $75 | $300 | $300 | $150 | ||||
| Maximums | ||||||||
| Major Annual Max (age 19 and older) | $750 | $500 | $500 | No Maximum | ||||
| Annual Max per Person (age 19 and older) | $1,000 | $1,000 | $1,000 | No Maximum | ||||
| Orthodontic Lifetime Max (Medically Necessary / Non-Medically Necessary) |
No Maximum / $1,000 | No Maximum / Not Applicable | No Maximum / Not Applicable | No Maximum / Not Applicable | ||||
| Pediatric EHB Annual Max | No Maximum | No Maximum | No Maximum | No Maximum | ||||
| Pediatric Individual EHB Out-of-Pocket Max (up to age 19**) |
$375 | $375 | $375 | $375 | ||||
| Pediatric Family EHB Out-of-Pocket Max (up to age 19**) |
$750 | $750 | $750 | $750 | ||||
| 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 Insurance 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 Companion Life Insurance Company.
**Through the last day of the month in which the Insured turns 19 years of age
The Companion Life EMI Health dental plans have been reviewed and approved by the Wisconsin Office of the Commissioner of Insurance. They meet all Federal regulations, fulfilling the requirements of the Affordable Care Act for individuals. General Policy Provisions