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EMI Marketplace Advantage Copay Dental Plan
The EMI Marketplace Advantage Copay Dental Plan offers comprehensive dental coverage, with 100% coverage for preventative care and fixed copays for other services, ensuring predictable costs. Waiting periods of six months for basic work and 12 months for major work are in place, with a $50 deductible for individuals and a $150 deductible for families. What's even better is that there's no maximum yearly benefit, providing peace of mind for your oral health needs. Choose EMI Marketplace Advantage Copay Dental Plan for affordable, hassle-free dental care.
Carrier
EMI
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.
Plan Year
2024
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.
Individual Deductible
$50
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
$150
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.
Preventative Care
Preventive care is the cornerstone of maintaining good health. It encompasses regular check-ups, screenings, vaccinations, and lifestyle choices aimed at proactively warding off potential health issues. By prioritizing preventive care, individuals can often catch health problems at an earlier, more treatable stage and reduce the overall burden of illness. It's a smart investment in one's well-being that promotes a healthier, happier life.
Minor Dental Services
Minor work coverage under our plan offers flexibility and affordability. With a copay ranging from a 25% to 80% discount, you'll have significant savings on procedures like fillings, extractions, and more. While there's a short 6-month waiting period, this coverage ensures that you can address minor dental issues without breaking the bank, helping you maintain your oral health with ease and financial peace of mind.
Major Dental Services
Our major work coverage provides valuable support when you need it most. While there's a 12-month waiting period, it offers up to a 50% discount on the copay for procedures such as crowns, bridges, and root canals. This means that even for significant dental treatments, you can benefit from substantial savings, making essential dental care more accessible and affordable when you need it most.
Orthodontia for Children
For kids under 18, our orthodontia coverage is designed to promote healthy smiles. When you choose an in-network dentist, you can receive a valuable up to 25% discount on orthodontic treatments. This ensures that children can access necessary orthodontic care with cost-saving benefits, making it easier for families to invest in their children's long-term dental health and confidence.
Implant Coverage
Please note that this plan does not cover dental implants. While we provide comprehensive coverage for many dental procedures, dental implants fall outside the scope of our benefits. If you have specific concerns or needs related to implants, we recommend consulting with your dentist or exploring alternative coverage options that may suit your requirements.
Maximum Yearly Dental Benefit
This plan offers the advantage of an unlimited maximum yearly benefit. This means you can receive dental care without any concerns about reaching a coverage limit, providing peace of mind and assurance that your oral health needs will be fully supported throughout the year.
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.
Helpful Links
Schedule a consultation with a local Utah health insurance agent
We're happy to meet with your in-person or over the phone to help you with your health insurance needs. We can help you with health insurance on or off the marketplace, Medicare Advantage & supplements, dental insurance, vision insurance, life insurance or accident plans. Thank you for letting us be your advocate. Best part, is our help is always free!
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.
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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.