EMI Health Premier PPO (High) - 48872ID0010001 Health Insurance Plan

48872 health insurance plan with the Plan ID 48872ID0010001. The plan is called EMI Health Premier PPO (High).

Health Insurance Plan ID 48872ID0010001
Health Insurance Plan Year 2023
State Idaho
Health Insurance Issuer 48872
Health Insurance Plan Variant 48872ID0010001-01
Provider Network(s) ['IDN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 07 May 2024 06:08 GMT).

Providers Idaho 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
Available Variants of the Health Plan

Standard On Exchange Plan - 48872ID0010001-01

Last Plan Update Date Mon, 23 Jan 2023 00:00 GMT
Last Import Date Tue, 07 May 2024 06:08 GMT

EMI Health Premier PPO (High) Health Insurance Plan Variant 48872ID0010001-01 Attributes

Plan Attribute Value
Business Year 2023
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard High On Exchange Plan
Dental Only Plan Yes
EHB Apportionment for Pediatric Dental 89.64%
First Tier Utilization 100%
HIOS Product ID 48872ID001
Import Date 1/23/2023
Guaranteed Rate Guaranteed Rate
IsItANewPlan Existing
Issuer ID 48872
Market Coverage Individual
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family $375 per person | $750 per group
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out $375
Medical EHB Deductible, Combined In/Out of Network, Family $25 per person | $75 per group
Medical EHB Deductible, Combined In/Out of Network, Individual $25
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
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
Metal Level High
Multiple In Network Tiers No
National Network Yes
Network ID IDN001
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 (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description PPO network or out-of-network coverage at PPO fee
Plan Effective Date 1/1/2023
Plan Expiration Date 12/31/2023
Plan ID (Standard Component ID with Variant) 48872ID0010001-01
Plan Marketing Name EMI Health Premier PPO (High)
Plan Type PPO
Plan Variant Marketing Name EMI Health Premier PPO (High)
QHP/Non QHP Both
Service Area ID IDS001
Source Name SERFF
Plan ID 48872ID0010001
State Code ID
Version Number 1
Wellness Program Offered No

Copay & Coinsurance of EMI Health Premier PPO (High) Health Insurance Plan, 48872ID0010001

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about EMI Health Premier PPO (High), 48872ID0010001 Health Insurance Plan, 48872ID0010001

  • Does EMI Health Premier PPO (High) Health Insurance Plan, 48872ID0010001 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

    • Does (48872ID0010001) Health Insurance Plan, Variant (48872ID0010001-01) have Out Of Country Coverage?

    Yes. 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 (a “Non U.S. Provider”) are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the following conditions: - Benefits may not be assigned to a Non U.S. Provider; - The Participant is responsible for making all payments to Non U.S. Providers, and submitting receipts to the Plan for reimbursement; - Benefit payments will be determined by the Plan based upon the exchange rate in effect on the incurred date; - The Non U.S. Provider shall be subject to, and in compliance with, all U.S. and other applicable licensing requirements; and - Claims for benefits must be submitted to the Plan in English and include a complete description of the services rendered.

    Does (48872ID0010001) Health Insurance Plan, Variant (48872ID0010001-01) have Out of Service Area Coverage?

    Yes. Details: PPO network or out-of-network coverage at PPO fee

 

Disclaimer: This is based on the import(Date: Tue, 07 May 2024 06:08 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API