EMI Health Plans for:
University of Utah Voluntary Students
Undergraduate students enrolled for six (6) or more credit hours each semester and graduate students enrolled in three (3) or more credit hours are eligible to enroll in these insurance plans.
All rates below are shown as cost per month. When you select a plan to “Add to Cart”, you will see a popup message prompting you to select the number of dependents. You will then fill in additional enrollment information during the checkout process.
Dental Plans
Advantage Co-Pay
The Advantage Co-Pay dental plan gives you peace of mind knowing what your out-of-pocket expense will be before going to any in-network provider. The plan uses a set copay fee schedule for services and has 100-percent coverage on in-network preventive dental care. Included is a discount on in-network orthodontic care.
$18.00
Subscriber only$37.50
Subscriber & Spouse$40.30
Subscriber with children$60.70
FamilyAdvantage Co-Pay
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In-Network
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Out-of-Network
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Type 1 - Preventive
Oral Exams, Cleanings, X-rays, Fluoride
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100% | See Claim Payment Schedule | |
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Type 2 - Basic
Fillings, Oral Surgery
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See Co-Pay Schedule | ||
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Type 3 - Major
Crowns, Bridges, Prosthodontics
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Type 4 - Orthodontics
Dependent Children (up to age 19)
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No Coverage | No Coverage | |
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Adults
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No Coverage | No Coverage | |
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Orthodontic Discount
All Members *
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25% Discount | No Discount | |
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Endodontics
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Type 3 - See Co-Pay Schedule | Type 3 - See Claim Payment Schedule | |
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Periodontics
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Type 3 - See Co-Pay Schedule | Type 3 - See Claim Payment Schedule | |
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Sealants
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Type 2 - See Co-Pay Schedule | Type 2 - See Claim Payment Schedule | |
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Space Maintainers
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Type 2 - See Co-Pay Schedule | Type 2 - See Claim Payment Schedule | |
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Specialists ** (see note below)
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20% Discount Only - see co-payment schedule | No Coverage | |
| ** 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, periodontist, prosthodontists, and orthodontists) are used, insureds receive a discount only. There is no beneift for non-participating specialists. | |||
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Waiting Periods
Type 2 - Basic
Type 3 - Major
Type 4 - Orthodontics
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3 Month Waiting Period
12 Month Waiting Period
N/A
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Deductible
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In and Out of Network Deductibles are Combined | ||
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Per Person
Family Max
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$25.00
$75.00
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$25.00
$75.00
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Deductible Applies To
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Type 2 & Type 3 | ||
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Annual Maximum Per Person
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N/A | ||
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Orthodontic Lifetime Maximum
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N/A | ||
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Network / Reimbursement Schedule
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Advantage | Advantage | |
| Provisions / Limitations / Exclusions | |||
| Exams, Cleanings and Floride | 2 per year |
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Floride |
Up to age 16 |
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Sealants |
Up to age 16 |
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Space Maintainers |
Up to age 16 |
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Bitewing X-Rays |
Up to 4, twice per year |
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Periapical X-Rays |
6 per year |
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Panoramic X-Ray |
1 every 3 years |
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Impacted Teeth |
Covered in Type 2 - Basic |
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Anesthesia (Age 8 and over for the extraction of impacted teeth only) |
Covered in Type 3 - Major |
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Anesthesia (For children age 7 and under, once per year) |
Covered in Type 3 - Major |
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Implants |
Not Covered |
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Crowns, Pontics, Abutments, Overlays and Dentures |
1 every 5 years per tooth |
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Fillings on the same surface |
1 every 18 months |
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Monthly Rates
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$18.00 Subscriber
$37.50 Subscriber + Spouse
$40.30 Subscriber + Child(ren)
$60.70 Subscriber + Spouse + Child(ren)
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| 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 Table of Allowances. When using a Non-participating Provider, the insured is responsible for all fees in excess of the Table of Allowances. | |||
| * The discount shown is for participating orthodontists in Utah. Discounts may vary outside of Utah. | |||
| Co-Pays/Claim Payments are subject to change January 1st of each year. Underwritten by Educators Health Plans Life, Accident, and Health. | |||
Vision Plans
VSP Plus 10-130
The VSP Plus 10-130 vision plan provides affordability and flexibility, with a rich in-network benefit that allows you to choose from more than 50,000 VSP providers across the nation, as well as an out-of-network benefit. The plan includes a $130 allowance for frames or for permanent and disposable contact lenses in lieu of frames and lenses.
$10.60
Subscriber only$20.60
Subscriber & Spouse$32.70
Subscriber with children$32.70
FamilyVSP Plus 10-130
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In-Network
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Out-of-Network
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Network
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VSP Choice Plus | |
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Well Vision Exam
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$10 Co-pay | Up to $65 |
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Lenses (glass or plastic)
single vision
lined bifocal
lined trifocal
linticular
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$10 Co-pay
$10 Co-pay
$10 Co-pay
$10 Co-pay
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Up to $30
Up to $50
Up to $65
Up to $100
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Lens Options
progressive (std. no-line)
premium progressive options
custom progressive options
plastic gradient dye
solid plastic dye
photochromic lenses
polcarbonate for adult
polycarbonate for child (under 18)
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$55 Co-pay
$95-$105 Co-pay
$150-$175 Co-pay
$17 Co-pay
$15 Co-pay
$70 Co-pay SV / $82 Co-pay Multifocal
$31 Co-pay SV / $35 Co-pay Multifocal
$0 Co-pay
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Up to $50
(In lieu of Lined Bifocal
reimbursement)
N/A
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Coatings
scratch resistant
anti-reflective
UV protection
additional lens enhancements
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$17 Co-pay
$41 Co-pay
$16 Co-pay
Up to 25% Discount
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N/A |
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Frames
allowance based on retail
**additional pairs
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$130 allowance at any VSP doctor or $70 at Costco, Sam's Club or Walmart
Up to 20% Off Retail
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Up to $80
N/A
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Elective Contact Lenses
In Lieu of Frame & Lenses Elective contact lens fitting, evaluation services and prescription contact lenses are covered up to plan allowance. 15% discount given off contact lens fitting and evaluation services, excluding materials.
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$130 Allowance | Up to $115 |
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Frequency
exam, lenses, frame or contacts
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Every 12 Months
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Refractive Surgery
***LASIK
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Up to $500 in Savings | Not Covered |
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Rates
Subscriber
Subscriber +1
Subscriber +2 or more
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$10.60
$20.60
$32.70
$32.70
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Plans are underwritten by Educators Health Plans Life, Accident, and Health.
** 20% discount off unlimited additional pairs of glasses offered through any VSP Choice Providers within 12 months of last covered eye exam.
*** Discounts average 15-20% off or 5% off a promotional offer for laser surgery, including PRK, LASIK, Custom LASIK, and IntraLase3.
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