EMI Marketplace Choice PPO High Dental Plan
EMI Health's Choice PPO Plan is a rich dental benefit plan. This plan is a coinsurance plan, which means EMI shares your costs for covered dental services and procedures. Once you've met your deductible, they will pay a percentage of your bill. You can choose to visit dentists in different networks based on your needs.
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 health plan's plan year typically spans from January 1st to December 31st. 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.
Maximum out-of-pocket refers to the highest amount you'll have to pay for covered medical expenses in a given period, including deductibles and co-payments. Once you reach this limit, your insurance covers 100% of eligible expenses.
Preventative care in dental insurance encompasses essential services aimed at maintaining oral health and preventing dental problems before they become more severe and costly to treat. These services typically include routine dental check-ups, professional cleanings, and X-rays. The key objective of preventative care is to detect and address dental issues in their early stages, preventing the need for more extensive and expensive treatments like root canals or crowns. Dental insurance plans often prioritize preventative care by covering it at little to no cost for policyholders. This means that individuals can schedule regular check-ups and cleanings without incurring significant out-of-pocket expenses.
Minor Dental Services
Basic dental work includes amalgam and resin-based composite fillings to address cavities and tooth decay. It also covers simple extractions, offering relief for painful or damaged teeth. In case of dental emergencies causing pain, insurance ensures timely treatment. Regular consultations are included to monitor and maintain oral health. This comprehensive dental insurance coverage helps individuals address various dental needs, promoting good oral health and providing peace of mind in case unexpected issues arise.
Major Dental Services
Major dental coverage includes deep sedation or general anesthesia for major procedures, such as oral surgery or complex extractions. It extends to composite fillings for tooth restorations, periodontal treatments for gum health, and crown services for restoring damaged teeth. Additionally, major dental work coverage includes endodontic therapy (root canals) and prosthodontic services, such as fixed partial dentures and dental retainers like inlays/onlays.
Orthodontia for Children
Dental insurance that covers orthodontia for kids is a valuable investment in their long-term oral health and well-being. Orthodontic coverage typically includes braces and other corrective treatments to align misaligned teeth and correct bite issues. By providing financial support for these services, dental insurance ensures that children receive the necessary orthodontic care, helping to enhance their dental function and aesthetics.
Implant coverage is typically not included in standard dental insurance plans. However, a local insurance agent can be a valuable resource in helping you find a dental insurance plan that offers coverage for dental implants. These agents have knowledge of the local insurance market and can guide you to specialized dental plans or riders that may provide the coverage you need for dental implants. This assistance can make a significant difference in ensuring you receive the necessary dental care while managing costs effectively.
Maximum Yearly Dental Benefit
The maximum yearly benefit in dental insurance represents the highest amount that the policy will pay per person on the plan within a given 12-month period. This benefit limit is essential to understanding the extent of coverage a dental insurance plan provides. Typically, it resets precisely 12 months from the date of signing up for the plan. Once this reset occurs, the policyholder's coverage renews, and any unused benefits from the previous year do not carry over. Therefore, individuals should be mindful of their maximum yearly benefit to make the most of their dental insurance and ensure that they receive necessary treatments and services while staying within the plan's financial 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.
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.
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.