EMI Choice PPO High Dental Plan
EMI Health's Choice High PPO Dental Plan stands out as a comprehensive dental benefit option that offers valuable coverage for families. Notably, this plan includes a $1,000 orthodontia benefit for children, which becomes available after a 24-month waiting period. For routine dental services, once you've met your deductible, the plan provides coverage by paying a percentage of your dental bills, making it easier to manage the costs of essential treatments. An attractive feature of this plan is its immediate coverage for preventative care, offering 100% coverage from the start. Basic dental work, such as cavity treatments, is covered after a 6-month waiting period, with the plan contributing 80% of the cost. For major procedures like root canals and crowns, there's a 15-month waiting period, after which the plan covers 50% of the expenses. While the plan offers flexibility in choosing different dentists based on your needs, it does come with a maximum annual benefit, ranging from $1,000 to $1,500 per person, depending on your selected dentist.
The company that provides and manages your insurance coverage. You pay your insurance premiums, which are regular payments to maintain your coverage, directly to the carrier.
A dental plan year typically spans one year from when you enrolled in the plan. At the start of each new year, plans reset, and any deductibles, out-of-pocket maximums, and benefits calculations begin anew.
Individual and Family Deductible
Dental insurance plans offer individual and family deductibles to accommodate varying needs. Individual deductibles require a specific out-of-pocket payment before insurance coverage applies to dental procedures, while family deductibles consolidate these costs for the entire family's dental expenses.
These plans typically categorize dental work into minor and major procedures. Minor work covers routine treatments like fillings and simple extractions, with insurance sharing the cost. In contrast, major work, which includes procedures such as root canals or crowns, often requires a larger patient contribution. It's important to note that the deductible normally doesn't apply to preventative care, such as check-ups and cleanings, which are often covered at no cost, emphasizing their role in maintaining oral health without additional financial burden.
A deductible is the amount you pay out of your own pocket before your insurance coverage starts. It's a way to share costs between you and the insurance company.
Family deductible is the amount the entire family, or everyone enrolled on the plan, must meet before insurance pays a portion of your covered services.
The EMI Health's Choice High PPO Dental Plan places a strong emphasis on preventive dental care, making it a particularly valuable option for those looking to maintain their oral health proactively. One of its standout features is the immediate coverage for preventive care, providing 100% coverage right from the start. This means that members can access essential preventive services such as regular check-ups, cleanings, and X-rays without any out-of-pocket expenses, making it both convenient and cost-effective to prioritize oral health. By covering preventive care comprehensively, the plan encourages individuals and families to stay on top of their dental check-ups, detect issues early, and prevent the development of more extensive and costly dental problems. This commitment to preventive care underscores the plan's dedication to supporting overall well-being through accessible and comprehensive dental coverage.
Minor Dental Services
The EMI Health's Choice High PPO Dental Plan provides valuable coverage for minor dental work, offering a well-rounded approach to managing common oral health issues. After a manageable 6-month waiting period, the plan steps in to cover 80% of the cost for basic treatments like fillings, ensuring that individuals can address cavity-related concerns with affordable financial support. This approach not only encourages timely dental care but also helps alleviate the financial burden associated with routine procedures. With the combination of the waiting period and the substantial coverage, this plan strikes a balance between accessibility and cost-effectiveness, ultimately empowering members to take proactive measures to maintain their oral health without significant financial strain.
Major Dental Services
The EMI Health's Choice High PPO Dental Plan extends coverage for major dental work, understanding the importance of addressing more extensive oral health concerns. After a 15-month waiting period, the plan provides coverage for major procedures like root canals and crowns, contributing 50% of the treatment costs. While the waiting period requires some patience, it is designed to ensure the plan's sustainability and affordability. This approach encourages members to plan and budget for significant dental procedures while benefiting from the substantial cost-sharing offered by the plan. By covering major work, the plan ensures that individuals can access the necessary treatments to restore their oral health and confidence, making it a comprehensive choice for addressing a wide range of dental needs.
Orthodontia for Children
The EMI Health's Choice High PPO Dental Plan provides a valuable orthodontia benefit for children, making it an appealing option for families with growing kids. After a 24-month waiting period, the plan offers a generous $1,000 orthodontia benefit, which can help cover the costs of orthodontic treatments such as braces or aligners. This feature acknowledges the importance of orthodontic care in ensuring children's oral health and smiles. While the waiting period requires some patience, it is designed to balance the plan's affordability with comprehensive coverage for orthodontic needs. By offering this benefit, the plan empowers families to plan for and access orthodontic treatments when necessary, ensuring that children receive the care they need to achieve healthy and confident smiles.
The EMI Health's Choice High PPO Dental Plan prides itself on delivering affordable dental coverage while maintaining a focus on essential services. It's important to note that the plan does not include coverage for dental implants. Dental implant procedures are highly specialized and often come with substantial costs. By excluding coverage for implants, this plan can offer more budget-friendly premiums, ensuring that individuals and families can access vital dental care without facing exorbitant expenses. While dental implants may not be covered, the plan prioritizes preventive, minor, and major dental work, providing a well-rounded approach to oral health that balances accessibility with cost-effectiveness. For those seeking implant-related treatments, alternative financing options or supplemental insurance plans designed specifically for implants may be explored, allowing individuals to tailor their dental coverage to their specific needs while benefiting from the affordability of this plan for other dental services.
Maximum Yearly Dental Benefit
The EMI Health's Choice High PPO Dental Plan offers flexibility in annual maximum benefits to accommodate different dental care needs. For Advantage Plus network dentists, the plan provides a maximum annual benefit of $1,500, ensuring substantial coverage for a range of dental treatments. Premier network dentists, while still offering comprehensive care, come with a maximum annual benefit of $1,000, providing an option for those seeking a slightly more budget-conscious approach. Additionally, the plan sets a cap of $750 for major services per year, offering a safeguard against higher expenses for extensive dental procedures. This tailored approach allows members to choose the level of coverage that aligns with their preferences and dental care requirements, ensuring that they can access the care they need while staying within their budgetary constraints.
Full Summary of Benefits and Helpful Links
Official documents, such as your insurance policy or Summary of Benefits and Coverage (SBC), outline the details of your coverage, including deductibles, copayments, and covered services. Provider links, often available through your insurance company's website, offer directories of in-network healthcare professionals and facilities, helping you find the right doctors and hospitals that are covered by your plan. Utilizing these resources can empower you to make informed healthcare decisions and effectively navigate your insurance coverage.
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This is a quick snapshot of the most popular copays, deductibles, and coinsurance that you would be responsible for on this dental plan. Preventative services include dental cleanings, exams and x-rays. Most plans cover your preventative care every 6 months with no waiting period. Basic dental work includes minor services like filling a cavity and may have a waiting period before these services will be covered on your plan. Major work includes services like crowns and root canals and may have a waiting period before these services are covered. Dentures and implants are normally NOT included in dental insurance. If you need coverage for these services, please let your local agent know so that you have a plan that includes those services.
To learn what each of the terms mean, please visit our terms and definitions page. Copays and coinsurance listed are amounts that you would pay after deductible unless specified otherwise. This is not a full list of services included on the plan. This snapshot is not guaranteed to be accurate. To verify plan benefits or for full details please see the full summary of benefits or or get a complete terms of coverage on the health plan carrier's website.
***Out of Network Limitations and Balance Billing
Some dental plans offer out of network coverage. This is a great benefit because you can visit any dentist in the nation. Which means that if you are traveling, or have a dental emergency, you can visit a dentist for the service you need right away and have a portion of your bill covered by your dental insurance. Please note that if you see an out of network provider, that dentist is allowed to "balance bill" you. This means that your dental insurance company pays your dentist what is reasonable and customary for the services you received. In most situations that dentist accepts that payment and you are only responsible for your portion of the bill. Occasionally, that dentist will decide that the reasonable and customary amount they received from the dental insurance is not enough. That dentist will bill you for the additional charge or 'balance bill' you. You are responsible to pay this amount or contact the dentist to work out a payment plan.