EMI Health Group Plans for: University of Utah Voluntary Students

Below you will see plans for the following EMI Health products: DentalVision

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dental Plans:
Advantage Co-Pay
starting at
$18.00
per month
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.
In-Network
Out-of-Network
Type 1 - Preventive
Oral Exams, Cleanings, X-rays, Fluoride
100% See Claim Payment Schedule
Type 2 - Basic
Fillings, Oral Surgery
See Co-Pay Schedule
Type 3 - Major
Crowns, Bridges, Prosthodontics
Type 4 - Orthodontics
Dependent Children (up to age 19)
No Coverage No Coverage
Adults
No Coverage No Coverage
Orthodontic Discount
All Members *
25% Discount No Discount
Endodontics
Type 3 - See Co-Pay Schedule Type 3 - See Claim Payment Schedule
Periodontics
Type 3 - See Co-Pay Schedule Type 3 - See Claim Payment Schedule
Sealants
Type 2 - See Co-Pay Schedule Type 2 - See Claim Payment Schedule
Space Maintainers
Type 2 - See Co-Pay Schedule Type 2 - See Claim Payment Schedule
Specialists ** (see note below)
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.
Waiting Periods
Type 2 - Basic
Type 3 - Major
Type 4 - Orthodontics
 
3 Month Waiting Period
12 Month Waiting Period
N/A
Deductible
In and Out of Network Deductibles are Combined
Per Person
Family Max
$25.00
$75.00
 
$25.00
$75.00
Deductible Applies To
Type 2 & Type 3
Annual Maximum Per Person
N/A
Orthodontic Lifetime Maximum
N/A
Network / Reimbursement Schedule
Advantage Advantage
Provisions / Limitations / Exclusions
Exams, Cleanings and Floride
2 per year
Floride
Up to age 16
Sealants
Up to age 16
Space Maintainers
Up to age 16
Bitewing X-Rays
Up to 4, twice per year
Periapical X-Rays
6 per year
Panoramic X-Ray
1 every 3 years
Impacted Teeth
Covered in Type 2 - Basic
Anesthesia (Age 8 and over for the extraction of impacted teeth only)
Covered in Type 3 - Major
Anesthesia (For children age 7 and under, once per year)
Covered in Type 3 - Major
Implants
Not Covered
Crowns, Pontics, Abutments, Overlays and Dentures
1 every 5 years per tooth
Fillings on the same surface
1 every 18 months
Monthly Rates
$18.00
Subscriber
$37.50
Subscriber + Spouse
$40.30
Subscriber + Child(ren)
$60.70
Subscriber + Spouse + Child(ren)
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
starting at
$10.60
per month
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.
In-Network
Out-of-Network
Network
VSP Choice Plus
Well Vision Exam
$10 Co-pay Up to $65
Lenses (glass or plastic)
single vision
lined bifocal
lined trifocal
linticular
 
$10 Co-pay
$10 Co-pay
$10 Co-pay
$10 Co-pay
 
Up to $30
Up to $50
Up to $65
Up to $100
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)
 
$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
 
Up to $50
(In lieu of Lined Bifocal
reimbursement)
 
 
N/A
 
 
Coatings
scratch resistant
anti-reflective
UV protection
additional lens enhancements
 
$17 Co-pay
$41 Co-pay
$16 Co-pay
Up to 25% Discount
N/A
Frames
allowance based on retail
**additional pairs
 
$130 allowance at any VSP doctor or $70 at Costco, Sam's Club or Walmart
Up to 20% Off Retail
 
Up to $80
N/A
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.
$130 Allowance Up to $115
Frequency
exam, lenses, frame or contacts
Every 12 Months
Refractive Surgery
***LASIK
Up to $500 in Savings Not Covered
Rates
Subscriber
Subscriber +1
Subscriber +2 or more
 
$10.60
$20.60
$32.70
$32.70
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.