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EMI Marketplace Choice PPO Dental Plan
The EMI Marketplace Choice PPO Dental Plan offers a comprehensive range of benefits that prioritize your oral health and financial well-being. With 100% coverage on preventive services, such as regular check-ups and cleanings, you can maintain a healthy smile without worrying about out-of-pocket expenses. After a reasonable 6-month waiting period, you'll enjoy 80% coverage on minor dental procedures, ensuring that issues like fillings and extractions are addressed affordably. Even major dental work, like crowns and root canals, becomes accessible with 50% coverage after an 18-month waiting period. Plus, the plan offers a generous $1,500 maximum benefit, providing you with the peace of mind that your dental needs are taken care of while keeping your budget in check. Choose EMI Marketplace Choice PPO Dental Plan for a brighter, healthier smile and financial security.
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
$25
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
$75
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 a healthy lifestyle. It encompasses a range of proactive measures, from regular medical check-ups and vaccinations to a balanced diet and exercise routine. By prioritizing preventive care, individuals can detect and address potential health issues early, ultimately reducing the risk of more serious conditions. Preventive care not only enhances overall well-being but also minimizes healthcare costs in the long run, making it an essential aspect of maintaining a happy and fulfilling life.
Minor Dental Services
Our dental plan's coverage for minor dental work is designed to provide flexibility and affordability. After a reasonable 6-month waiting period, members can access this vital benefit. With an impressive 80% coverage for advantage network dentists and 70% coverage for premier network dentists, you have the freedom to choose the dental professional who best suits your needs while enjoying substantial financial assistance. This coverage ensures that common procedures like fillings and extractions are not only accessible but also budget-friendly, helping you maintain your oral health with peace of mind. It's a testament to our commitment to delivering quality dental care while keeping your costs in check.
Major Dental Services
Our dental plan offers comprehensive coverage for minor dental work, prioritizing your oral health and financial well-being. After a reasonable 18-month waiting period, you can take advantage of this essential benefit. With a 50% coverage rate for both advantage and premier network dentists, you have the flexibility to choose your preferred dental professional while enjoying substantial financial assistance for procedures like fillings and extractions. Plus, the plan provides an annual maximum benefit of $500 for major dental work, ensuring that even significant treatments remain manageable. This demonstrates our commitment to providing you with access to quality dental care while safeguarding your budget.
Orthodontia for Children
Our orthodontic coverage for children up to 19 years old is designed to support healthy smiles and confident growth. We're delighted to offer up to a remarkable 25% discount when you choose an in-network dentist for your child's orthodontic needs. This means that whether it's braces or other orthodontic treatments, you can provide your child with the best care without breaking the bank. We understand that a straight, healthy smile is an investment in their future, and our discount ensures that you can prioritize their oral well-being while also benefiting from significant savings. Choose our plan to help your child achieve a beautiful, straight smile while keeping costs affordable.
Implant Coverage
Please note that our dental plan, while comprehensive in many aspects, does not cover dental implants. Dental implants are a specialized and often costly dental procedure, and we want to be transparent about the limitations of our coverage. While we prioritize preventive care, minor, and major dental work, including routine check-ups and treatments, dental implants fall outside the scope of our coverage. We recommend discussing alternative options or specialized insurance coverage for dental implants with your dental provider or insurance agent to ensure you receive the appropriate care for your specific needs. Our plan remains committed to helping you maintain excellent oral health within its covered services.
Maximum Yearly Dental Benefit
Our dental plan offers different maximum yearly benefits based on your choice of dental providers. For advantage network dentists, you can enjoy a generous maximum yearly benefit of $1,500, ensuring comprehensive coverage for your oral health needs. If you opt for premier network or out-of-network dentists, you still receive substantial coverage with a maximum yearly benefit of $1,000. However, it's important to note that for major dental work, there is a maximum allowance of $500. These benefit structures are designed to provide you with flexibility and financial support, regardless of your choice of dental provider, while emphasizing the importance of preventive care and cost-effective treatment options.
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.