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MVP Premier Plus Gold 12, Gold, NS, INN, NY Individual Off Exchange HMO, Dep29, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness
Health Insurance Plan Details (2025 Plan)
by MVP Health Care
Monthly Premium
HMO
$ubsidy
Gold
- Deductible
- $0 /yr
- Max Out-of-Pocket
- $5,800 /yr
Details
| Deductible (per individual) | $0 /yr |
| Deductible (per family) | $0 /yr |
| Max Out-of-Pocket (per individual) | $5,800 /yr |
| Max Out-of-Pocket (per family) | $11,600 /yr |
| Drug Deductible (per individual) | |
| Drug Deductible (per family) | |
| Drug Max Out-of-Pocket (per individual) | |
| Drug Max Out-of-Pocket (per family) | |
| Plan Type | HMO |
| Includes Child Dental? | No |
| Includes Adult Dental? | No |
Out-of-Pocket Costs
| Preventive Care | No Charge |
| Primary Care Visit | Not Applicable |
| Specialist Visit | 50.00% Coinsurance |
| Emergency Room | 50.00% Coinsurance |
| Inpatient Facility | 50.00% Coinsurance |
| Inpatient Physician | 50.00% Coinsurance |
| Generic Drugs | 50.00% Coinsurance |
| Preferred Brand Drugs | 50.00% Coinsurance |
| Non-preferred Brand Drugs | 50.00% Coinsurance |
| Specialty Drugs | 50.00% Coinsurance |
Plan Documents
| Summary of Benefits and Coverage | SBC doc |
| Provider Directory | Doctor lookup |
| Drug Formulary List | n/a |
* Figures shown are only for in-network medical costs
** Please check with insurance company if Copay and Coinsurance rates are before or after the deductible
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