GET TO KNOW YOUR COVERAGE

Your EMI Health Dental Plan

Learn how your plan works, what’s covered, and how to get the most from your dental coverage.

TYPES OF PLANS

Understanding Dental Plans

EMI Health offers a range of plan options to fit different needs. 

Be sure to check your plan summary(ies)—found at the back of your enrollment booklet to see which dental plan(s) you may choose from.

Regardless of type of plan, with EMI Health, you have access to a nationwide network of trusted dentists, making it easier to get care wherever you are.

icon_ppo@300x

PPO Plans

Go to any dentist, but save more in-network.
With a PPO plan, you can usually visit any licensed dentist, but you’ll pay less if you choose one in the plan’s network. These plans typically cover preventive care (like cleanings and exams) at 100% and offer partial coverage for basic and major services.

Best for: Employees who want flexibility and are willing to pay more for it.

  • checkmark@300x Freedom to see out-of-network providers
  • checkmark@300x No referrals needed for specialists
  • checkmark@300x Often includes a deductible and coinsurance
icon_Copay@300x

Copay Plans

Predictable costs, limited network.
Copay plans list set dollar amounts for each dental service. You know upfront what you’ll pay.

Best for: Employees who want budget certainty.

  • checkmark@300x Fixed fees for each procedure
  • checkmark@300x Often no deductible or coinsurance
icon_dental_cleaning@300x

DHMO Plans

Lowest cost, but most restrictions.
DHMO plans require members to choose a primary dentist from the network. That dentist manages all care and referrals. Services are either free or have low copays.

Best for: Employees looking for the most affordable dental option and willing to stay in-network.

  • checkmark@300x No deductible or annual maximum
  • checkmark@300x Must see your assigned dentist
  • checkmark@300x No coverage for out-of-network care

 

Please note: Plan features and coverage levels may vary based on your employer’s specific dental plan. Be sure to review your official plan summary for the exact benefits, costs, and provider details that apply to you.

CLEANINGS, FILLINGS, AND MORE

Understand the four main types of dental coverage categories—and how your plan helps cover each one.

  • Preventive Care

  • Basic Services

  • Major Services

  • Orthodontics

icon_dental_cleaning@300xIncludes cleanings, checkups, and routine X-rays. These are usually covered at a higher level and may not require you to pay anything out-of-pocket when you use an in-network provider.

icon_dental_extractions@300xIncludes treatments like fillings and simple extractions. These services are often shared between you and the plan, depending on your specific benefits.

icon_dental_crowns@300xIncludes crowns, bridges, dentures, and other more involved procedures. These are typically covered at a lower percentage and may come with higher out-of-pocket costs.
icon_dental_ortho@300xCovers braces and other alignment services. If your plan includes orthodontic coverage, it typically has a lifetime maximum per person. This means the plan will only pay up to a certain amount for orthodontic care—ever.
plan_summary_types-100

Where to Find Your Coverage Details

Every dental plan is a little different. To see exactly what your plan covers for each type of care—check the plan benefits summary in your enrollment booklet OR your plan documents in your My EMI Health account online dashboard, if you are a member.

HOW MUCH DOES THE PLAN PAY?

A Few Important Things to Know

The amount your plan pays depends on the type of care and your specific dental plan. Each category—preventive, basic, major, and orthodontic—may be covered at different levels.

 

To find out exactly how your plan pays for care, refer to the plan summary in the back of your enrollment booklet.

Deductible

A deductible is the amount you pay out of pocket each year for certain dental services before your insurance begins to pay its portion. Deductibles may apply per person and per family, depending on your plan.

Waiting Periods

A waiting period is the amount of time you must be enrolled in your dental plan before certain types of care are covered. While preventive services like cleanings and exams are usually covered immediately, other services may have a delay.

Annual Maximum

The total amount the plan will pay for dental care each year. This maximum is usually listed as per person and per family. Once you reach this amount, you’ll pay any additional costs out-of-pocket.

FINAL ADVICE

Not all employers offer every plan type. Once you’ve answered these questions, check the top section of your plan summary for:

• The plan name and effective date
• The "Network/Reimbursement Schedule" line
• The "Benefit Year" and maximum coverage per year

QUESTIONS TO ASK YOURSELF

Choosing the Right Dental Plan

Picking the right dental plan depends on your needs. Here’s some things to consider:

Do you want to keep your current dentist?

Step 1:

Use our Provider Search Page to check before you choose a plan. Staying in-network saves you money.

Some plans only cover in-network providers, while others allow out-of-network coverage at a reduced rate.
Look for:
• "In-Network vs Out-of-Network" section (often near the top chart)
• "Network / Reimbursement Schedule"
• Terms like MAC, R&C, or No Coverage

Tip:
If your dentist is not in the network, look for plans that reimburse using MAC (Maximum Allowable Charge) or R&C (Reasonable & Customary)—these allow some out-of-network flexibility.

Are you covering a spouse or kids?

Check how dependents are covered, especially for services like orthodontics or sealants.
Look for:
  • "Dependent Coverage" in the orthodontics or preventive sections
  • Age limits listed under fluoride, sealants, or orthodontics
  • “Type 4 – Orthodontics” section

Tip:
Most plans cover sealants and fluoride only up to age 16, and orthodontics for children 7–18.

Will you or your family need braces?

Orthodontic coverage isn’t always included—and often has strict limits.
Look for:
• "Type 4 – Orthodontics"
• “Discount Only,” “No Coverage,” or specific coinsurance (%)

Tip:
Some plans cover orthodontics for children only, and only in-network. Adult orthodontics is often listed as “Discount Only” or not covered.

Do you expect major dental work (like crowns or dentures)?

These fall under Type 3 – Major services and can be expensive.
Look for:
• "Type 3 – Major" coverage percentages
• Frequency limitations (e.g., “1 every 5 years per tooth”)
• Implant and anesthesia coverage

Tip:
Major services are usually covered at 40%–50% in PPOs, but copay plans often use fixed fees listed in a separate schedule.

Do you want predictable, fixed costs for each dental visit?

Copay or DHMO plans offer set fees instead of percentages.
Look for:
• “See Co-Pay Schedule” or “Fee Schedule” under most categories
• No coinsurance percentages
• In-network only benefits

Tip:
If it says “See Co-Pay Schedule” in most sections and shows $0 deductibles, it’s a copay-style plan. These are good if you prefer cost certainty.

Are you only planning on getting cleanings and exams?

All plans include preventive care, but the cost and network rules may vary.
Look for:
• "Type 1 – Preventive"
• Coverage level (typically 100%)
• “In-Network” column vs “Out-of-Network” coverage

Tip:
Preventive services are almost always free in-network, but out-of-network coverage may be limited or not covered at all on some plans.

Are you okay with paying a little more each month for more provider flexibility?

Plans with wider provider access usually come with higher premiums.
Look for:
• Monthly rates (Employee / Two-Party / Family)
• Out-of-Network reimbursement details
• “MAC” or “R&C” language

Tip:
Compare premiums shown at the bottom of the summary with flexibility offered in the coverage chart. PPO plans often cost more but let you see more dentists.

STATE-BY-STATE COVERAGE

EMI Health Dental Networks by State

  • Utah

  • Arizona

  • Texas

  • Georgia

State of Utah sking moutaints-1

Utah

Premier Network
Large PPO network.
In and out-of-network coverage
3,900+ dentists in Utah
 
Advantage (Plus) Network
Great discounts.
No annual maximums
Set co-pay schedule
3,000+ providers in Utah
 
TDA PPO
Set Copays for most services
Specialist care included, including pediatric
2,700+ providers in Utah
 
DHMO UT
No annual maximums, deductibles, or waiting periods
Includes General and Specialist Dentists
Most routine preventive care $0
 
Value Discount
A discount dental program, not an insurance product.
Lowest annual cost
Set member fees
Need to find a provider near you?
Whether you're in a city or a rural area, chances are there's an in-network provider near you. Use our Provider Search Tool to explore your options and take full advantage of your plan.
 
FIND A DENTAL PROVIDER
State of Arizona typical landscape image-1

Arizona

Summit Network
Cigna dental network. More dentists. More locations.
121,000 dentists nationwide
715,000 access points nationwide

Premier Network
Large Dentemax PPO network. More coverage.
73,000 dentists nationwide
277,000 listed access points nationwide 
 
Advantage Network
Careington dental network.
Great discounts.
No annual maximums
Set co-pay schedule
67,000 dentists nationwide
 
DHMO AZ
One of the largest DHMO networks in Arizona
No annual maximums, deductibles, or waiting periods
Includes General and Specialist Dentists
4,000+ providers in Arizona
 
Value Discount
A discount dental program, not an insurance product.
Lowest annual cost
Set member fees
 
Need to find a provider near you?
Whether you're in a city or a rural area, chances are there's an in-network provider near you. Use our Provider Search Tool to explore your options and take full advantage of your plan.
FIND A DENTAL PROVIDER
Texas familiar landscape

Texas

Summit Network
Cigna dental network. More dentists. More locations.
121,000 dentists nationwide
715,000 access points nationwide

Premier Network
Large Dentemax PPO network. More coverage.
73,000 dentists nationwide
277,000 listed access points nationwide 
 
Advantage Network
Careington dental network.
Great discounts.
No annual maximums
Set co-pay schedule
67,000 dentists nationwide
 
Value Discount
A discount dental program, not an insurance product.
Lowest annual cost
Set member fees
Need to find a provider near you?
Whether you're in a city or a rural area, chances are there's an in-network provider near you. Use our Provider Search Tool to explore your options and take full advantage of your plan.
FIND A DENTAL PROVIDER
State of Georgia-2

Arizona

Summit Network
Cigna dental network. More dentists. More locations.
121,000 dentists nationwide
715,000 access points nationwide

Premier Network
Large Dentemax PPO network. More coverage.
73,000 dentists nationwide
277,000 listed access points nationwide 
 
Advantage Network
Careington dental network.
Great discounts.
No annual maximums
Set co-pay schedule
67,000 dentists nationwide
 
Value Discount
A discount dental program, not an insurance product.
Lowest annual cost
Set member fees
Need to find a provider near you?
Whether you're in a city or a rural area, chances are there's an in-network provider near you. Use our Provider Search Tool to explore your options and take full advantage of your plan.
MAKE SURE YOUR PROVIDER IS COVERED UNDER YOUR PLAN

How to Search for In-network Providers

To get the most from your EMI Health benefits—and avoid unexpected costs—it’s important to see providers in your plan’s network. That starts with two simple steps:

 Step 1: Find Your Plan’s Network 

Before you search, you’ll need to know which network your plan uses. You can find this in your plan summary, located in the back of your enrollment booklet or in your EMI Health member portal after you enroll.

dental_network_summaryLook for names like:

  • Premier
  • Advantage (Plus)
  • DHMO
  • Summit
  • Or other regional or specialty networks

 Step 2: Use the Provider Search Tool 

dental_provider_search

Visit: emihealth.com/ProviderSearch
Then follow these steps:

  1. Select your network from the dropdown list. (Use the name you found in your plan summary.)
  2. Choose your provider type (e.g., dental, medical, vision).
  3. Enter your ZIP code or city to see local providers.
  4. Filter by specialty, gender, language, or other preferences.

Why It Matters

Seeing an in-network provider means:

  • Lower out-of-pocket costs
  • No surprise billing
  • Simplified claims and coverage

If you're unsure about your network, reach out to EMI Health Member Services—we're here to help you find the care you need.

AdobeStock_574547163

 Start Your Search for In-Network Care

PROVIDER SEARCH

Out-of-Network Coverage: MAC vs. R&C

If you visit a dentist who isn't part of your plan's network, your dental insurance will determine how much it pays based on one of two methods:

Feature MAC (Maximum Allowable Charge) R&C (Reasonable & Customary)
How reimbursement is calculated Limited to the plan's max allowoable  Based on average fees in your area for similar services
Plan payment Limited to the plan's max allowable amount Based on typical local charges (often higher than MAC)
Your cost You pay the difference if your dentist charges more than the plan allows You pay the difference if the charge exceeds the "customary" limit
Flexibility Lower reimbursement out-of-network More generous reimbursement out-of-network
Best for Members who stay in-network Members who may need to go out-of-network
Typical reimbursement level Lower Often higher than MAC

 

Tip: To minimize unexpected expenses, always check if your dentist is in-network using our Provider Search Page. For detailed information about your plan's out-of-network coverage, refer to your plan summary located at the back of your enrollment booklet or access your plan documents through the EMI Health member portal after enrollment.

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REAL HELP FROM REAL PEOPLE

Customer Service

Whether you’re looking for help with benefits, claims, ID cards, or something else—we’ve got a knowledgeable, friendly team ready to assist.

Call our Member Services team
(800) 262-5851
Monday - Friday 6:00 am - 6:00 pm

 

OR send us an email at cs@emihealth.com

We’re committed to making your experience as smooth as possible. If something doesn’t make sense, just ask—we’ll walk you through it.