EMI Health offers this marketplace health insurance plan (Plan ID 40335UT0020001) 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: HighPlan type: PPOCSR: Standard High On Exchange PlanIssuer: EMI Health
Telehealth
Data pending
HSA eligible
Check with issuer
Dental
Adult/Child
Vision
Not listed
Marketplace enrollment for 2026 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Utah). 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 High 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).
Variant 40335UT0020001-01 (Standard On Exchange Plan) currently displayed.
Advertisement
Benefits
Covered services & limitations
Pregnancy & family
Maternity, newborn, pediatric dental and vision extras.
Basic Dental Care - Child
$63.00 Copay after deductible
Tier 1 in-network$63.00 Copay after deductible
Out-of-network$120.00 Copay after deductible
Copays listed are average copays for this benefit category. For detailed copays by service please reference the copay schedule linked to the Advantage Copay plan brochure. Basic services for children apply to the deductible, but do not apply to the pediatric EHB out of pocket maximum. Benefits illustrated are in summary only. Refer to your Dental Policy for a complete description of benefits, limitations and exclusions.
Exclusions: Space Maintainers not covered after age 16. Fillings on the same surface 1 every 18 months. Basic benefits covered after 6 month waiting period.
Major Dental Care - Child
$80.00 Copay after deductible
Tier 1 in-network$80.00 Copay after deductible
Out-of-network$135.00 Copay after deductible
Copays listed are average copays for this benefit category. For detailed copays by service please reference the copay schedule linked to the Advantage Copay plan brochure. Major services for children apply to the deductible, but do not apply to the pediatric EHB out of pocket maximum. Benefits illustrated are in summary only. Refer to your Dental Policy for a complete description of benefits, limitations and exclusions.
Exclusions: Anesthesia for those age 8 and over is only covered for the extraction of impacted teeth. Anesthesia for those age 7 and under is covered once per year. Crowns, Pontics, Abutments, Onlays and Dentures are covered 1 every 5 years per tooth. Benefits covered after 12 month waiting period.
Issuer did not share extra notes for this benefit beyond the summary above.
Basic Dental Care - Adult
$60.00 Copay after deductible
Tier 1 in-network$60.00 Copay after deductible
Out-of-network$117.00 Copay after deductible
Copays listed are average copays for this benefit category. For detailed copays by service please reference the copay schedule linked to the Advantage Copay plan brochure. Benefits illustrated are in summary only. Refer to your Dental Policy for a complete description of benefits, limitations and exclusions.
Exclusions: Space Maintainers not covered after age 16. Fillings on the same surface 1 every 18 months. Basic benefits covered after 6 month waiting period.
Dental Check-Up for Children
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network$12.00 Copay after deductible
Limit: 2.0 Visit(s) per Year
Limit applies to Exams, Cleanings and Fluoride. Vertical Bitewing X-rays up to 8 per year. Periapical X-rays Up to 14 during any 3 year period. Panoramic X-Ray is allowed 1 every 3 years. Copays listed are average copays for this benefit category. For detailed copays by service please reference the copay schedule linked to the Advantage Copay plan brochure. Benefits illustrated are in summary only. Refer to your Dental Policy for a complete description of benefits, limitations and exclusions. Fluoride and Sealants not covered after the end of the month the enrollee turns age 19.
Major Dental Care - Adult
$209.00 Copay after deductible
Tier 1 in-network$209.00 Copay after deductible
Out-of-network$378.00 Copay after deductible
Copays listed are average copays for this benefit category. For detailed copays by service please reference the copay schedule linked to the Advantage Copay plan brochure. Benefits illustrated are in summary only. Refer to your Dental Policy for a complete description of benefits, limitations and exclusions.
Exclusions: Anesthesia only covered for the extraction of impacted teeth. Crowns, Pontics, Abutments, Onlays and Dentures are covered 1 every 5 years per tooth. Benefits covered after 12 month waiting period.
Orthodontia - Adult
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Orthodontia - Child
Coverage details pending
Issuer did not share extra notes for this benefit beyond the summary above.
Routine Dental Services (Adult)
No Charge after deductible
Tier 1 in-networkNo Charge after deductible
Out-of-network$13.00 Copay after deductible
Limit: 2.0 Visit(s) per Year
Limit applies to Exams, Cleanings and Fluoride. Vertical Bitewing X-rays up to 8 per year. Periapical X-rays Up to 14 during any 3 year period. Panoramic X-Ray is allowed 1 every 3 years. Copays listed are average copays for this benefit category. For detailed copays by service please reference the copay schedule linked to the Advantage Copay plan brochure. Benefits illustrated are in summary only. Refer to your Dental Policy for a complete description of benefits, limitations and exclusions. Fluoride and Sealants not covered after the end of the month the enrollee turns age 19.
Variant attributes
EMI Health Advantage Co-Pay · Variant 40335UT0020001-01
Plan identifiers & tier
Issuer-provided metadata for this variant.
Business Year
2026
CSR Variation Type
Standard High On Exchange Plan
HIOS Product ID
40335UT002
Metal Level
High
Plan ID (Standard Component ID with Variant)
40335UT0020001-01
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
40335
Issuer Marketplace Marketing Name
EMI Health
Market Coverage
Individual
Multiple In Network Tiers
No
National Network
Yes
Network ID
UTN002
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
UTS001
State Code
UT
Cost sharing & actuarial values
Issuer-provided metadata for this variant.
Begin Primary Care Deductible Coinsurance After Number Of Copays
0
Inpatient Copayment Maximum Days
0
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group
$900 per group
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person
$450 per person
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out
$450
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group
per group not applicable
Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person
per person 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 Group
per group not applicable
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Person
per person not applicable
Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual
Begin Primary Care Cost-Sharing After Number Of Visits
0
Child-Only Offering
Allows Adult and Child-Only
Composite Rating Offered
No
Dental Only Plan
Yes
EHB Apportionment for Pediatric Dental
0.771154776
First Tier Utilization
100%
Import Date
10/15/2025
Guaranteed Rate
Guaranteed Rate
New/Existing Plan
Existing
Medical EHB Deductible, Combined In/Out of Network, Family Per Group
$150 per group
Medical EHB Deductible, Combined In/Out of Network, Family Per Person
$50 per person
Medical EHB Deductible, Combined In/Out of Network, Individual
$50
Medical EHB Deductible, In Network (Tier 1), Family Per Group
per group not applicable
Medical EHB Deductible, In Network (Tier 1), Family Per Person
per person not applicable
Medical EHB Deductible, In Network (Tier 1), Individual
Not Applicable
Medical EHB Deductible, Out of Network, Family Per Group
per group not applicable
Medical EHB Deductible, Out of Network, Family Per Person
per person not applicable
Medical EHB Deductible, Out of Network, Individual
Not Applicable
Plan Effective Date
1/1/2026
Plan Expiration Date
12/31/2026
Plan Type
PPO
QHP/Non QHP
On the Exchange
Source Name
SERFF
Plan ID
40335UT0020001
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 Utah?
EMI Health Advantage Co-Pay (40335UT0020001) is a High PPO from EMI Health in Utah for the 2026 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 add-ons: Adult, Child.
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?
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.
