EMI Health Premier PPO (Low) - 40519MO0010002 Health Insurance Plan

Educators Health Plans Life, Accident, and Health, Inc health insurance plan with the Plan ID 40519MO0010002. The plan is called EMI Health Premier PPO (Low).

Health Insurance Plan ID 40519MO0010002
Health Insurance Plan Year 2025
State Missouri
Health Insurance Issuer Educators Health Plans Life, Accident, and Health, Inc
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 40519MO0010002-01
Provider Network(s) PREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 GMT).

Providers Missouri All US States
All 710 889
PCP 1 1
Allergy N/A N/A
OB/GYN N/A N/A
Dentists 420 544
Available Variants of the Health Plan

Standard On Exchange Plan - 40519MO0010002-01

Last Plan Update Date Tue, 17 Sep 2024 00:00 GMT
Last Import Date Tue, 03 Dec 2024 06:24 GMT

Benefits of EMI Health Premier PPO (Low) Health Insurance Plan, 40519MO0010002-01

Benefit Covered In Network Out Of Network
Accidental Dental
NO
Basic Dental Care - Adult

Exclusions: Space Maintainers not covered after the end of the month the enrollee turns age 19. Fillings on the same surface 1 every 18 months. Basic benefits covered after 6 month waiting period.

Benefits illustrated are in summary only. Refer to the plan brochure for additional details.

YES

40.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Basic Dental Care - Child

Exclusions: Space Maintainers not covered after the end of the month the enrollee turns age 19.

Benefits illustrated are in summary only. Refer to the plan brochure for additional details.

YES

40.00% Coinsurance after deductible

50.00% Coinsurance after deductible
Dental Check-Up for Children

Limit: 2.0 Visit(s) per Year

Limit applies to Exams, Cleanings and Fluoride. Vertical Bitewing X-rays up to 8 films every 6 months. Panoramic X-Ray is allowed 1 every 3 years. Fluoride and Sealants not covered after the end of the month the enrollee turns age 19. Benefits illustrated are in summary only. Refer to the plan brochure for additional details.

YES

0.00% Coinsurance after deductible

20.00% Coinsurance after deductible
Major Dental Care - Adult

Exclusions: Anesthesia only covered when medically or dentally necessary. Implants are not covered. Crowns, Pontics, Abutments, Onlays and Dentures are covered 1 every 5 years per tooth. Waiting period applies.

Benefits illustrated are in summary only. Refer to the plan brochure for additional details.

YES

60.00% Coinsurance after deductible

70.00% Coinsurance after deductible
Major Dental Care - Child

Exclusions: Anesthesia is only covered when medically or dentally necessary. Implants not covered after the end of the month the enrollee turns age 19. Crowns, Pontics, Abutments, Onlays and Dentures are covered 1 every 5 years per tooth.

Benefits illustrated are in summary only. Refer to the plan brochure for additional details.

YES

60.00% Coinsurance after deductible

70.00% Coinsurance after deductible
Orthodontia - Adult
NO
Orthodontia - Child

Exclusions: Covered up to the end of the month the enrollee turns age 19.

Only Medically Necessary Ortho is covered. Benefits illustrated are in summary only. Refer to the plan brochure for additional details.

YES

50.00%

50.00%
Routine Dental Services (Adult)

Limit: 2.0 Visit(s) per Year

Limit applies to Exams, Cleanings and Fluoride. Vertical Bitewing X-rays up to 8 films every 6 months. Panoramic X-Ray is allowed 1 every 3 years. Fluoride and Sealants not covered after the end of the month the enrollee turns age 19. Benefits illustrated are in summary only. Refer to the plan brochure for additional details.

YES

0.00% Coinsurance after deductible

20.00% Coinsurance after deductible

EMI Health Premier PPO (Low) Health Insurance Plan Variant 40519MO0010002-01 Attributes

Plan Attribute Value
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2025
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Low On Exchange Plan
Dental Only Plan Yes
EHB Apportionment for Pediatric Dental 1.0
First Tier Utilization 100%
HIOS Product ID 40519MO001
Import Date 2024-09-17 01:02:01
Inpatient Copayment Maximum Days 0
Guaranteed Rate Guaranteed Rate
New/Existing Plan Existing
Issuer ID 40519
Issuer Marketplace Marketing Name EMI Health
Market Coverage Individual
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group $850 per group
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person $425 per person
Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out $425
Medical EHB Deductible, Combined In/Out of Network, Family Per Group $300 per group
Medical EHB Deductible, Combined In/Out of Network, Family Per Person $100 per person
Medical EHB Deductible, Combined In/Out of Network, Individual $100
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
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 Not Applicable
Metal Level Low
Multiple In Network Tiers No
National Network Yes
Network ID MON001
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
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 40519MO0010002-01
Plan Marketing Name EMI Health Premier PPO (Low)
Plan Type PPO
Plan Variant Marketing Name EMI Health Premier PPO (Low)
QHP/Non QHP On the Exchange
Service Area ID MOS001
Source Name HIOS
Plan ID 40519MO0010002
State Code MO
URL for Enrollment Payment URL

Copay & Coinsurance of EMI Health Premier PPO (Low) Health Insurance Plan, 40519MO0010002

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

Frequently Asked Questions(FAQ) about EMI Health Premier PPO (Low), 40519MO0010002 Health Insurance Plan, 40519MO0010002

  • Does EMI Health Premier PPO (Low) Health Insurance Plan, 40519MO0010002 support Mail Ordering?

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

  • Does (40519MO0010002) Health Insurance Plan, Variant (40519MO0010002-01) 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 are payable under the Plan, subject to all Plan exclusions, limitations, maximums and other provisions, under the conditions outlined in the policy.

    Does (40519MO0010002) Health Insurance Plan, Variant (40519MO0010002-01) 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, 03 Dec 2024 06:24 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