EMI Health Premier PPO (High)

93383NC0010001
High
PPO

EMI Health Premier PPO (High) is a High PPO plan by EMI Health.

Locations

EMI Health Premier PPO (High) is offered in the following counties.

Plan Overview

This is a plan overview for 2025 version of EMI Health Premier PPO (High) 93383NC0010001.
Insurer: EMI Health
Network Type: PPO
Metal Type: High
HSA Eligible?:
Plan ID: 93383NC0010001

Cost-Sharing Overview

EMI Health Premier PPO (High) offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for EMI Health Premier PPO (High)?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

EMI Health Premier PPO (High) offers the following features and referral requirements.

Wellness Program:
Disease Program:
Notice Pregnancy:
Referral Specialist:
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what EMI Health Premier PPO (High) covers when you are out of the service area or out of the country.

Out of Country Coverage: Yes
Out of Country Coverage Description: Dental expenses for care, supplies, or services which are rendered by a Provider whose principal place of business or address for payment is located outside the United States are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the conditions outlined in the policy.
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: PPO network or out-of-network coverage at PPO fee
National Network: Yes

Additional Benefits and Cost-Sharing

EMI Health Premier PPO (High) includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Routine Dental Services (Adult)
Covered
Not Applicable 0.00% Coinsurance after deductibleNot Applicable 0.00% Coinsurance after deductible2.0 Visit(s) per Year Limit applies to Exams, Cleanings and Fluoride. Vertical Bitewing X-rays up to 8 films every 6 months. Panoramic X-Ray is allowed 1 every 3 years. Fluoride and Sealants not covered after the end of the month the enrollee turns age 19. Benefits illustrated are in summary only. Refer to the plan brochure for additional details.
Dental Check-Up for Children
Covered
Not Applicable 0.00% Coinsurance after deductibleNot Applicable 0.00% Coinsurance after deductible2.0 Visit(s) per Year Limit applies to Exams, Cleanings and Fluoride. Vertical Bitewing X-rays up to 8 films every 6 months. Panoramic X-Ray is allowed 1 every 3 years. Sealants are covered 1 per tooth every 36 months. Fluoride and Sealants not covered after the end of the month the enrollee turns age 19. Benefits illustrated are in summary only. Refer to the plan brochure for additional details.
Basic Dental Care – Child
Covered
Not Applicable 20.00% Coinsurance after deductibleNot Applicable 20.00% Coinsurance after deductible Space Maintainers not covered after the end of the month the enrollee turns age 19. Benefits illustrated are in summary only. Refer to the plan brochure for additional details.
Orthodontia – Child
Covered
Not Applicable 50.00%Not Applicable 50.00% Covered up to the end of the month the enrollee turns age 19. Only Medically Necessary Ortho is covered. Benefits illustrated are in summary only. Refer to the plan brochure for additional details.
Major Dental Care – Child
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible Anesthesia is only covered when medically or dentally necessary. Implants not covered after the end of the month the enrollee turns age 19. Crowns, Pontics, Abutments, Onlays and Dentures are covered 1 every 5 years per tooth. Benefits illustrated are in summary only. Refer to the plan brochure for additional details.
Basic Dental Care – Adult
Covered
Not Applicable 20.00% Coinsurance after deductibleNot Applicable 20.00% Coinsurance after deductible Space Maintainers not covered after the end of the month the enrollee turns age 19. Fillings on the same surface 1 every 18 months. Basic benefits covered after 6 month waiting period. Benefits illustrated are in summary only. Refer to the plan brochure for additional details.
Orthodontia – Adult
Not Covered
Major Dental Care – Adult
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible Anesthesia only covered when medically or dentally necessary. Implants are not covered. Crowns, Pontics, Abutments, Onlays and Dentures are covered 1 every 5 years per tooth. Waiting period applies. Benefits illustrated are in summary only. Refer to the plan brochure for additional details.
Accidental Dental
Not Covered

Free Preventive Services

There is no copayment or coinsurance for any of the following EMI Health Premier PPO (High) preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Ready to sign up for EMI Health Premier PPO (High)?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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