36160 offers this marketplace health insurance plan (Plan ID 36160PA0010003) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.
Metal level: LowPlan type: PPOCSR: Standard Low On Exchange PlanIssuer: 36160
Telehealth
Data pending
HSA eligible
Check with issuer
Dental
Not listed
Vision
Not listed
2025 cost summary
Key premiums & cost sharing
Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.
Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Pennsylvania). Submit changes before the deadline to avoid a coverage gap.
Enroll by Dec 15 for Jan 1 starts.
Finalize plan switches before the window closes.
Special Enrollment Periods
You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).
Report the event within 60 days.
Keep documentation handy for Healthcare.gov or your state exchange.
CSR & subsidy reminders
Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.
Enter accurate income to maximize Advanced Premium Tax Credits.
Standard Low On Exchange Plan plans like this one keep deductibles and copays lower if you qualify.
Thinking about switching?
Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.
Match provider networks so ongoing care isn’t disrupted.
Confirm prescriptions stay on-formulary or budget for tier changes.
Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.
Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).
All providers in PennsylvaniaN/A
PCPs in PennsylvaniaN/A
Telehealth supportData pending
Nationwide providersN/A
N/A doctors statewideN/A PCPsN/A OB/GYN
Provider network(s)
['PREFERRED']
Providers
Pennsylvania
All US states
All
N/A
N/A
PCP
N/A
N/A
Allergy
N/A
N/A
OB/GYN
N/A
N/A
Dentists
N/A
N/A
Drug coverage overview
0 drugs tracked
Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.
Prior authorization
Drugs
Required
0
Not Required
0
Step therapy
Drugs
Required
0
Not Required
0
Quantity limits
Drugs
Has Limit
0
No Limit
0
Customer highlights
What stands out for members
Issuer: 36160 · Plan ID 36160PA0010003 · 2025 filing.
Variant 36160PA0010003-01 (Standard On Exchange Plan) currently displayed.
Use the cards on this page to explore network stats, drug coverage, and cost-sharing details.
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Variant attributes
EMI Health Advantage Co-Pay · Variant 36160PA0010003-01
Plan identifiers & tier
Issuer-provided metadata for this variant.
Business Year
2025
CSR Variation Type
Standard Low On Exchange Plan
HIOS Product ID
36160PA001
Metal Level
Low
Plan ID (Standard Component ID with Variant)
36160PA0010003-01
Plan Marketing Name
EMI Health Advantage Co-Pay
Plan Variant Marketing Name
EMI Health Advantage Co-Pay
Issuer & service area
Issuer-provided metadata for this variant.
Issuer ID
36160
Market Coverage
Individual
Multiple In Network Tiers
No
National Network
Yes
Network ID
PAN002
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
Service Area ID
PAS001
State Code
PA
Cost sharing & actuarial values
Issuer-provided metadata for this variant.
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family
$425 per person | $850 per group
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out
$425
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family
per person not applicable | per group not applicable
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual
Not Applicable
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family
per person not applicable | per group not applicable
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual
Not Applicable
Additional attributes
Issuer-provided metadata for this variant.
Child-Only Offering
Allows Adult and Child-Only
Composite Rating Offered
No
Dental Only Plan
Yes
EHB Apportionment for Pediatric Dental
100%
First Tier Utilization
100%
Import Date
1/13/2025
Guaranteed Rate
Guaranteed Rate
IsItANewPlan
Existing
Medical EHB Deductible, Combined In/Out of Network, Family
$50 per person | $150 per group
Medical EHB Deductible, Combined In/Out of Network, Individual
$50
Medical EHB Deductible, In Network (Tier 1), Family
per person not applicable | per group not applicable
Medical EHB Deductible, In Network (Tier 1), Individual
Not Applicable
Medical EHB Deductible, Out of Network, Family
per person not applicable | per group not applicable
Medical EHB Deductible, Out of Network, Individual
Not Applicable
Plan Effective Date
1/1/2025
Plan Expiration Date
12/31/2025
Plan Type
PPO
QHP/Non QHP
On the Exchange
Source Name
SERFF
Plan ID
36160PA0010003
Version Number
1
Wellness Program Offered
No
Copay & coinsurance
Pharmacy cost sharing by tier
Drug tier
Pharmacy type
Copay amount
Copay option
Coinsurance rate
Coinsurance option
Mail order
Questions & answers
Frequently asked questions
How do I choose the right ACA plan in Pennsylvania?
EMI Health Advantage Co-Pay (36160PA0010003) is a Low PPO from 36160 in Pennsylvania for the 2025 coverage year.
Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.
Does EMI Health Advantage Co-Pay support telehealth or virtual urgent care?
The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.
Is EMI Health Advantage Co-Pay HSA-eligible and does it include dental or vision coverage?
HSA eligibility is not published; check the Summary of Benefits or ask the issuer.
Dental coverage is not listed for this plan.
Vision coverage is not listed for this plan.
Does EMI Health Advantage Co-Pay support mail-order prescriptions?
Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.
Is there out-of-country coverage for EMI Health Advantage Co-Pay?
Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: 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.
Does EMI Health Advantage Co-Pay cover care outside the service area?
Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: PPO network or out-of-network coverage at PPO fee
How do I enroll in or manage payments for EMI Health Advantage Co-Pay?
Use HealthPorta to shortlist plans, then finish enrollment through Healthcare.gov or your state-based marketplace.
Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
