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MVP Premier Plus Silver 12, Silver, NS, INN, NY Individual Off Exchange HMO, Dep25, Covered in full PCP to age 26, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness,
Health Insurance Plan Details (2025 Plan)
by MVP Health Care
Monthly Premium
HMO
$ubsidy
Silver
- Deductible
- $3,350 /yr
- Max Out-of-Pocket
- $9,200 /yr
Details
| Deductible (per individual) | $3,350 /yr |
| Deductible (per family) | $6,700 /yr |
| Max Out-of-Pocket (per individual) | $9,200 /yr |
| Max Out-of-Pocket (per family) | $18,400 /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 | $0 Copay |
| Specialist Visit | $50 Copay after deductible |
| Emergency Room | $350 Copay after deductible |
| Inpatient Facility | $1000 Copay per Stay after deductible |
| Inpatient Physician | $300 Copay after deductible |
| Generic Drugs | $0 Copay |
| Preferred Brand Drugs | $45 Copay after deductible |
| Non-preferred Brand Drugs | $90 Copay after deductible |
| Specialty Drugs | $90 Copay after deductible |
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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