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EMI Marketplace Choice PPO High Dental Plan
The EMI Choice PPO Plan offers flexibility and strong coverage options, making it a great fit for those who want the freedom to choose their dentist while still saving money. After your deductible, this plan covers preventive care like exams, cleanings, x-rays, sealants, and fluoride at 100% with no waiting period, helping you stay on top of your dental health right away. It covers basic services like fillings at 80% in the Advantage and Premier network and major services like crowns and root canals at 50%, giving you solid protection for both routine and more advanced care. This plan also includes coverage for orthodontics for children ages 7-18. You receive 50% coverage with a maximum of $1000 per child. The plan includes a low deductible starting at $25 per person (up to $75 per family) in the Advantage network, and $50 (up to $150 in the Premier network and out of network dentists). It also has waiting periods of 6 months for basic services and 15 months for major services, so it’s best suited for those planning ahead. With an annual maximum of up to $1,500 per person in the Advantage network (and $1,000 in the Premier network) with a maximum of $750 for major services, along with the ability to choose between networks for cost savings or provider flexibility, this plan is ideal for individuals and families who want greater choice, strong coverage, and the ability to customize how they receive care.
Carrier
EMI
Plan Year
2026
Individual and Family Deductible
Dental insurance deductibles work similarly to health insurance deductibles, but they apply specifically to dental care. Individual deductibles are the amount a person must pay out-of-pocket for covered dental services before the insurance starts covering a portion of the costs. In a family plan, each family member has their own individual deductible, but many plans also have a family deductible cap, meaning once the family’s combined spending reaches a certain limit, the insurance will kick in for all members. These deductibles generally apply to services like fillings, crowns, and other restorative treatments, but routine care such as cleanings and exams may be covered without needing to meet the deductible. Understanding how these work ensures you're prepared for any out-of-pocket costs when seeking dental care.
Individual Deductible
$25
Family Deductible
$75
Preventative Care
Invest in your oral health with our EMI Marketplace Choice PPO Dental Plan, providing 100% coverage on preventative care after you meet the deductible starting at $25 per person (up to $75 per family) in the Advantage network, and $50 (up to $150 in the Premier network and out of network dentists), ensuring your smile stays vibrant and trouble-free.
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 and meting the annual deductible, members can access this vital benefit. With an impressive 80% coverage for advantage and 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 after you've met the annual deductible. 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
This plan also includes coverage for orthodontics for children ages 7-18. You receive 50% coverage with a maximum of $1000 per child after a 24 month waiting period. All members can receive up to 25% discount on orthodontia after a 24 month waiting period.
Implant Coverage
While the EMI Marketplace Choice PPO High Dental Plan for 2024 offers comprehensive coverage for a wide range of dental services, it's important to note that dental implants are not covered under this plan. Dental implants are considered a specialized and elective procedure, and their cost can vary significantly. While this plan provides generous coverage for preventive, minor, and major dental work, including routine check-ups and essential treatments, it does not extend to the expenses associated with dental implant procedures. If you have specific needs related to dental implants, it's advisable to explore additional coverage options or discuss alternative solutions with your dental care provider.
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 dentists 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 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.
PPO Plans and 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 and contact the dentist to work out a payment plan.
