Utah health plan · 2026

U Health Plus Gold Standard · 42261UT0060025

University of Utah Health Insurance Plans offers this marketplace health insurance plan (Plan ID 42261UT0060025) 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: Gold Plan type: EPO CSR: Zero Cost Sharing Plan Variation Issuer: University of Utah Health Insurance Plans
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 100.00% (0.00% member share on average). Learn about AV methodology.

2026 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.

Monthly premium

$368 – $1392

Before subsidies

Estimate after subsidies

Deductible

$0

$0 per group

See deductible details

Max out-of-pocket

$0

$0 per group

Review MOOP rules

Office visits

Primary care $0.00, 0.00%
Specialist $0.00, 0.00%
HSA Not eligible

Drug tiers

Generic $0.00, 0.00%
Preferred brand $0.00, 0.00%

View formulary tiers

$645 / mo before subsidies

≈ $7741 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1741 / mo before subsidies

≈ $20889 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$2059 / mo before subsidies

≈ $24704 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1373 / mo before subsidies

≈ $16473 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

$0.00, 0.00%

Emergency Room Services

$0.00, 0.00%

Durable Medical Equipment

$0.00, 0.00%

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

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.
  • Zero Cost Sharing Plan Variation 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.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

$0.00, 0.00%

Emergency Room Services

$0.00, 0.00%

Durable Medical Equipment

$0.00, 0.00%

Premium snapshot

Plan identifiers & filings

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.

Plan ID 42261UT0060025
Coverage year 2026
State Utah
Issuer University of Utah Health Insurance Plans
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 42261UT0060025-02
Available variants

Standard Off Exchange Plan · 42261UT0060025-00

Standard On Exchange Plan · 42261UT0060025-01

Open to Indians below 300% FPL · 42261UT0060025-02

Open to Indians above 300% FPL · 42261UT0060025-03
Last plan update Wed, 15 Oct 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

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 Utah 13931
PCPs in Utah 1638
Telehealth support Data pending
Nationwide providers 17814
13,931 doctors statewide 1,638 PCPs 83 OB/GYN

Provider network(s)

Providers Utah All US states
All 13931 17814
PCP 1638 2196
Allergy 10 19
OB/GYN 83 109
Dentists 27 31

Drug coverage overview

4,314 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-BRANDS 3,677
SPECIALTY 632
PREFERRED-SPECIALTY-DRUGS 5
Prior authorization Drugs
Required 925
Not Required 3,389
Step therapy Drugs
Required 151
Not Required 4,163
Quantity limits Drugs
Has Limit 1,562
No Limit 2,752

Customer highlights

What stands out for members

  • Issuer: University of Utah Health Insurance Plans · Plan ID 42261UT0060025 · 2026 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 42261UT0060025-02 (Open to Indians below 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Diabetes Education

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Must be for the diagnosis of diabetes.

Home Health Care Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Benefit Period

Laboratory Outpatient and Professional Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Other Practitioner Office Visit (Nurse, Physician Assistant)

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Preventive Care/Screening/Immunization

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Primary Care Visit to Treat an Injury or Illness

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Rehabilitative Occupational and Rehabilitative Physical Therapy

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Benefit Period

Includes other outpatient rehabilitation services with a combined limit of 20 visits per plan year

Rehabilitative Speech Therapy

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Benefit Period

Includes other outpatient rehabilitation services with a combined limit of 20 visits per plan year

Specialist Visit

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Urgent Care Centers or Facilities

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

X-rays and Diagnostic Imaging

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Delivery and All Inpatient Services for Maternity Care

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Dialysis

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Durable Medical Equipment

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

DME over $1000, rentals, that exceed 60 days, or as indicated in Appendix A of the Master Policy require Pre-authorization.

Emergency Room Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Emergency Transportation/Ambulance

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Hospice Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Requires Pre-authorization and Medical Case Management.

Inpatient Hospital Services (e.g., Hospital Stay)

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Inpatient Physician and Surgical Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Mental/Behavioral Health Inpatient Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Requires Pre-authorization.

Mental/Behavioral Health Outpatient Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Office Visits may be subject to a Copay, All other outpatient services are subject to the deductible and coinsurance. See your SBC for more details.

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Outpatient Rehabilitation Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Benefit Period

Includes other outpatient rehabilitation services with a combined limit of 20 visits per plan year

Outpatient Surgery Physician/Surgical Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Radiation

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Skilled Nursing Facility

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Benefit Period

Requires Pre-authorization and Medical Case Management.

Substance Abuse Disorder Inpatient Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Requires Pre-authorization.

Substance Abuse Disorder Outpatient Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Office Visits may be subject to a Copay, All other outpatient services are subject to the deductible and coinsurance. See your SBC for more details.

Transplant

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Mental health & substance use

Behavioral health visits and substance use treatment.

Autism Spectrum Disorders

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Hearing Aids

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Major Dental Care - Child

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Prenatal and Postnatal Care

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Routine Eye Exam for Children

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 1.0 Visit(s) per Benefit Period

Well Baby Visits and Care

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Benefit should mirror preventive care/screening/immunization.

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Limit: 30.0 Item(s) per Month

Non-Preferred Brand Drugs

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Limit: 30.0 Item(s) per Month

Preferred Brand Drugs

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Limit: 30.0 Item(s) per Month

Specialty Drugs

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Limit: 30.0 Item(s) per Month

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Basic Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Dental Check-Up for Children

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Infusion Therapy

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Major Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Nutritional Counseling

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

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.

Prosthetic Devices

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Routine Dental Services (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Programs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Acupuncture

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Allergy Testing

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Charges for office visits in connection with repetitive injections are not covered. Sublingual or colorimetric allergy testing.

Bariatric Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Cosmetic Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Eye Glasses for Children

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 1.0 Item(s) per Benefit Period

Lenses only.

Habilitation Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Limit: 20.0 Visit(s) per Benefit Period

Includes other outpatient rehabilitation services with a combined limit of 20 visits per plan year

Imaging (CT/PET Scans, MRIs)

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Infertility Treatment

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Inherited Metabolic Disorder - PKU

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Long-Term/Custodial Nursing Home Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Private-Duty Nursing

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Reconstructive Surgery

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Out-of-network 100.00%

Covers mastectomy in the treatment of cancer and reconstructive surgery after a mastectomy.

Routine Eye Exam (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Routine Foot Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Treatment for Temporomandibular Joint Disorders

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Variant attributes

U Health Plus Gold Standard · Variant 42261UT0060025-02

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Zero Cost Sharing Plan Variation

HIOS Product ID

42261UT006

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

42261UT0060025-02

Plan Marketing Name

U Health Plus Gold Standard

Plan Variant Marketing Name

U Health Plus Gold Standard

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

42261

Issuer Marketplace Marketing Name

University of Utah Health Plans

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

UTN002

Out of Country Coverage

No

Out of Country Coverage Description

Emergent Only

Out of Service Area Coverage

No

Out of Service Area Coverage Description

Emergent Only

Service Area ID

UTS001

State Code

UT

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

1

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$0

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$0

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

$0

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$0

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

UTF003

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

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

No

Design Type

Design 1

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

EHB Percent of Total Premium

1

First Tier Utilization

100%

Import Date

10/15/2025

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Level Exclusions

See Plan Document

Plan Type

EPO

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

42261UT0060025

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

$0

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$0

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, Out of Network, Individual

$0

Unique Plan Design

No

Wellness Program Offered

Yes

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?

U Health Plus Gold Standard (42261UT0060025) is a Gold EPO from University of Utah Health Insurance Plans 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 U Health Plus Gold Standard 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 U Health Plus Gold Standard HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does U Health Plus Gold Standard support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with U Health Plus Gold Standard?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.

Is there out-of-country coverage for U Health Plus Gold Standard?

No, out-of-country services are not covered for this plan. Details: Emergent Only

Does U Health Plus Gold Standard cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies. Details: Emergent Only

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.
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