Dental Copay

Posted : admin On 1/30/2022

The Dental Select Copay Plan makes dental insurance easy and affordable. There are no annual maximums to track and all copayments are fixed. Plus, routine exams, cleanings, and fluoride treatments are 100% covered after a low deductible is met on all services.

No Annual Maximum

You pay a set amount (copay) when you receive dental services. Neither plan has an annual maximum that they pay for covered benefits (some specific exceptions apply). Referrals are required from your primary care dental provider to see a specialist. You may change providers in.

  • Diabetes mellitus has dental implications due to increased risk of infections, poor wound healing, rapid progression of periapical pathology, xerostomia, burning mouth syndrome, and a bidirectional link with periodontal disease. Two clinical cases of patients with diabetes are discussed and their dental management described.
  • Adult Dental Copay Select offers employees predictable costs on over 200 dental procedures and with our extensive Select network of over 1,000 providers, they’ll enjoy convenient access to quality dental.
  • The copay plan includes an unlimited maximum that applies to Preventive, Basic, and Major services on a per member, per calendar year basis.
  • EMI Health's Advantage Copay Plan is, as the name suggests, a copay plan. This means you have a fixed copay cost for covered dental services and procedures. You can know exactly how much a service or procedure will cost before you visit the dentist with the copay schedule.

There’s no annual maximum on your coverage, so you can utilize whatever benefits you need, as often as you need.

Network Options

Texas and Utah residents can choose between our regional Gold and Platinum networks at enrollment.

Short Waiting Periods

Take advantage of your full benefits within one year of your coverage start date.

Fixed Copay

Dental on a budget? Copays are fixed so you’ll always know what you’re going to pay prior to your appointment

Definition

Discounts

Dental Copay

Where available, discounts may be available on child and adult orthodontics, veneers, and teeth bleaching. Discount amounts may vary.

In-Network

Includes cleanings (2 per calendar year), exams, fluoride (14 & under) & x-rays
100%
100% Coverage of Fee Schedule
Includes fillings & oral surgery
Up to 70% Coverage (Copay applies)
Up to 70% Coverage of Fee Schedule

Dental Copay Assistance

6 Months
6 Months
Includes crowns, bridges, periodontics, endodontics & dentures
Up to 50% coverage
Up to 50% Coverage of Fee Schedule
12 Months
12 Months
Per calendar year. Applies to all services.
$25 per person / $75 per family
$25 per person / $75 per family

Dental Copay Calculator

Per member, per calendar year. Applies to services excluding orthodontics.
Unlimited
Unlimited
Children & Adults
None
None
N/A
N/A
N/A
N/A

FAQ

Available on our Gold or Platinum networks (Utah and Texas only).

Currently, Dental Select offers plan effective dates are on the first day of each calendar month. You may choose your effective date during the plan selection process, where you also enter your zip code and number of dependents.

Dependents can include a spouse or domestic partner and each unmarried child, from birth to age 26, who is living with you in a regular parent-child relationship and for whom you can claim an exception on your federal taxes.

Yes. EyeMed Discount Vision is included with every dental plan. This is based on applicable laws, and reduced costs may vary by doctor location.

Discount Vision and Connection Hearing are also included. This is based on applicable laws, and reduced costs may vary by doctor location.

Members receive a paid benefit for covered services provided by both contracted general and specialist providers.

The Copay plan is only available in Texas and Utah. Click here to download a brochure.

Your deductible applies to all services and must be fully satisfied before plan benefits take effect.

Plan Highlights

  • In-network preventive care is covered at 100%
  • Fixed copays for procedures make budgeting easy
  • No annual maximums
  • No waiting periods
  • Gold and Platinum network options

Legal

EXPENSES NOT COVERED: No benefits will be paid for expenses incurred:

In all states

  • for services related to, performed in conjunction with, or resulting from a non-covered procedure.
  • for charges in excess of the Contracted Fee Schedule or the Usual, Customary and Reasonable rate, whichever applies.
  • for any treatment program which begins prior to the date the Insured is covered under the Policy.
  • for crowns, inlays and onlays on teeth that can be restored by direct placement materials.
  • for the replacement of crowns, bridges, inlays, onlays or prosthetic appliances within 5 years from the date of last placement.
  • for any condition covered under any Workers’ Compensation Act or similar law.
  • for services applied without cost by any municipality, county or other political subdivision or for which there would be no charge in the absence of insurance.
  • for services that are applied toward the satisfaction of a Deductible, if any.
  • for services subject to a Benefit Waiting Period.
  • for charges resulting from changing from one provider to another while receiving treatment, or from receiving treatment from more than one provider for one dental procedure to the extent that the total charges billed exceed the amount incurred if one provider had performed all services.
  • for Hospital facility charges for any dental procedure, including but not limited to: emergency room charges, surgical facility charges, Hospital confinement.
  • for drugs or the dispensing of drugs.
  • for oral hygiene instruction; plaque control; acid etch; prescription or take-home fluoride; broken appointments; completion of a claim form; OSHA/sterilization fees (Occupational Safety & Health Agency); or diagnostic photographs (except for orthodontic purposes).
  • for implants (unless included in covered services); myofunctional therapy; athletic mouthguards; precision or semi-precision attachments; treatment of fractures, cysts, tumors, or lesions; maxillofacial prosthesis; orthognathic surgery; TMJ dysfunction; cleft palate; or anodontia.
  • for orthodontia, unless included within the Benefit Schedule.
  • for services to replace teeth that are missing (extracted or congenitally) prior to the Effective Date of the Policy. This limitation ends after 36 months of continuous coverage on the Policy. Abutment teeth will be reviewed for eligibility of prosthetic benefits.
  • for composite, resin, or white fillings on posterior primary teeth. Benefits will be reduced to that of an amalgam or silver filling.
  • for the replacement of a filling within 24 months of placement, unless for specific health reasons.
  • for the replacement of retainers.
  • for lab fees for higher metals or porcelain crowns, bridges, inlays, or onlays.
  • during travel or activity outside the United States.

In Texas and Utah only

  • for services and supplies not listed in the Benefit Schedule, not recognized as essential for the treatment of the condition according to accepted standards of practice or considered experimental, subject to the Right To Appeal provision contained in your Policy.
  • for cosmetic procedures, including but not limited to veneers and bleaching of teeth and procedures performed primarily for cosmetic reasons, subject to the Right To Appeal provision contained in your Policy.
  • for sealants not applied to permanent bicuspids or molars, applied at age 18 or older, applied 3 years from a previous sealant application, applied to a decayed tooth.

In all states, except Texas and Utah

  • for services and supplies not listed in the Benefit Schedule, not recognized as essential for the treatment of the condition according to accepted standards of practice or considered experimental.
  • for cosmetic procedures, including but not limited to veneers and bleaching of teeth and procedures performed primarily for cosmetic reasons.
  • for sealants not applied to permanent bicuspids or molars, applied later than the end of the month in which a child reaches age 19, applied 3 years from a previous sealant application, applied to a decayed tooth.
    This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit Us from providing insurance, including, but not limited to, the payment of claims.

This insurance does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit Us from providing insurance, including, but not limited to, the payment of claims.

Group Copay Dental Plans

With no waiting periods, no annual maximums, no deductibles (for groups of 6 or more enrolled employees), and fixed copayments for covered services, Dental Select’s unique Copay dental plans are the perfect combination of affordability and simplicity. Copay plans are currently available in Texas and Utah only.

Request a Quote

Our underwriters are standing by! To help expedite your quote request, click here for a list of required group details.

No Maximums

Enjoy the predictability of our fixed copay plan and the freedom to use your benefits the way you want, when you want. The copay plan includes an unlimited maximum that applies to Preventive, Basic, and Major services.

No Deductible

Groups with 6 or more enrolled employees can receive a $0 deductible. For groups with fewer employees, the deductible is $25 per member and $75 per family and applies to Basic and Major services.

No Waiting Periods

Yep, no waiting periods. This simplified plan is ideal with Preventive care covered at 100% and Basic and Major service co-pays set as fixed amounts, so you can best plan for your dental care at a pace that works for you.

In-Network

Includes routine exams, cleanings (2 per year), topical fluoride (14 & under), and x-rays.
Plan pays 100%
In-network contracted amount Member is responsible for balance.
After deductible - Fillings, extractions, and oral surgery.
Fixed co-pay Based on payment schedule
In-network contracted amount Member is responsible for balance.
After Deductible - Includes crowns, bridges, dentures, endodontics, periodontics.
Fixed co-pay Based on payment schedule
In-network contracted amount Member is responsible for balance.
Applies to Basic, & Major services.
$0 Per member/family, per calendar year
Applies to Basic, & Major services.
$25 per member / $75 per family, per calendar year.
$25 per member/ $75 per family, per calendar year.
Applies to Basic, & Major services.

Dental Copay Calculator

None
20% discount
20% discount

FAQ

Available on our Gold or Platinum networks (Utah and Texas only).

Most plans begin on the first of a calendar month. However, if you need a mid-month start we can accommodate that. Simply let us know your preferred effective date when you request a quote.

Eligible employees and any legal dependents. Dependents can include a spouse or domestic partner and each unmarried child, from birth to age 26, who is living with you in a regular parent-child relationship and for whom you can claim an exception on your federal taxes.

Yes. EyeMed Discount Vision is included with every dental plan. This is based on applicable laws, and reduced costs may vary by doctor location.

Not applicable for Employer plans.

Members receive a paid benefit for covered services provided by both contracted general and specialist providers.
Copay

Dental Select Gold

The Copay plan is only available in Texas and Utah. Click here to download a plan brochure.

Groups with 6 or more enrolled employees can enjoy the added value of a $0 deductible. For groups with fewer employees, the services to which a deductible would apply can be customized as part of the quote.

Plan Highlights

  • In-network preventive care is covered at 100%
  • No annual maximum
  • No deductible (for groups of 6+)
  • No waiting periods
  • Gold and Platinum network options