Frequently Asked Questions

Quick Links

General FAQs | Seeing a Provider | myVisitNow® | What’s Covered? | Emergency and Coverage Away From Home | Health Management Programs | Understanding Insurance | Prescription Benefits

Preventive Health Services (PDF) View the list of preventive health services covered in full under federal health care reform.

View Member Annual Notices

General FAQs

Seeing a Provider

  • How do I know what health care providers are in the MVP network?

    MVP offers many different health plans to meet the needs of employers and individuals. There are important differences between each of our health plans. You can identify providers in your network by using the Find a Doctor search. Enter your MVP Member ID number and location, and find doctors in your network. If you’re not an MVP member and don’t have an MVP Member ID number, you can search your providers by your plan type.


  • How much will I pay to see providers in the MVP network?

    Members may pay a co-payment or co-insurance toward a deductible for certain services. Health plans can include a network of health care providers that is local, regional (MVP’s service area includes New York and Vermont), or national. Ask your employer or look at your health plan materials for more information about your network, benefits, out-of-pocket costs and other important details.


  • Can I go to any doctor or hospital I want, or must I use MVP-participating doctors and hospitals?

    MVP has made arrangements with a large number of physicians, hospitals, laboratories and other health care organizations to provide services to our members. When you use a health care provider who is part of the MVP network (in-network), your health plan benefits will be applied to the cost of the medical care you get.

    You may search for participating doctors, hospitals and labs, and pharmacies.

    Some health plans include coverage for medical care you get from health care providers who are not part of the MVP network. These are called “out-of-network benefits.” If your health plan does not include out-of-network benefits, the MVP Medical Director may make arrangements for you to receive care with non-participating physicians and/or hospitals when it is medically necessary. In such cases, prior written approval must be obtained.

    Also, MVP will cover emergency care for members at non-participating hospitals or health care facilities, but you must seek any necessary follow-up care from MVP-participating providers.

    For coverage details, please look at your health plan materials or ask your employer if your health plan has out-of-network benefits.


  • Can I change my Primary Care Physician (PCP)?

    Yes. If you chose a PCP as a required part of your health plan coverage, you may change your PCP at any time. Simply Sign In to your account to change your PCP or call the MVP Customer Care Center at the phone number on the back of your MVP Member ID card.


  • Do I have to contact my Primary Care Physician (PCP) and request a referral before I see a specialist?

    MVP plans do not require referrals for specialists. Whether or not your health plan requires you to choose a PCP to coordinate your care, it is a good idea to talk with your doctor about any medical concern you have. Your doctor may then offer treatment or help you by recommending a specialist. You do not need a formal referral.


  • Do women who enroll in MVP need to choose an Obstetrician/Gynecologist (OB/GYN)?

    You may see any MVP-participating OB/GYN for appropriate, covered services without a referral from a PCP. Some MVP-participating OB/GYNs are also listed as Primary Care Physicians; you can choose to select one of them as your PCP. Visit our Find a Doctor search to find an OB/GYN or PCP.


  • How can I enhance communications with my providers?

    Written or verbal communication between Primary Care Physicians (PCPs), specialists, and other practitioners helps provide effective follow-up care and improved patient safety.

    Here are some tips that you can follow to help facilitate this process:

    • Always keep the name, phone number and address of your PCP handy. Even if the information is not asked for, offer to provide this information to other health care professionals you see.
    • Ask your health care professionals to send pertinent information to your PCP.
    • Keep copies of the following items from your medical record and bring them to each office visit in case the practitioner has not obtained them from your PCP:
      • Medication list
      • Recent physical exam
      • Important test results


  • My plan includes MVP preferred provider facilities. What are these facilities and where do I find them?

    MVP’s preferred provider facilities can help you save money on ambulatory/outpatient surgery, laboratory, and radiology services.

    If you have a deductible, medically necessary and covered services at one of these facilities are covered in full once your deductible is met.

    To find a list of preferred provider facilities in your area, use the Find a Doctor search and look for the MVP preferred provider facilities callout box, or go to the top menu bar in the Find a Doctor search, and select Find a Facility. The listing is located on the right side of the page under Additional Resources.


myVisitNow®

  • How do I access myVisitNow® for an online doctor visit?

    For more information on myVisitNow®, click here.


What’s Covered?

  • What preventive health services are covered in full as part of my plan?

    The Affordable Care Act (ACA) is about insuring more preventive health services for more Americans. MVP Health Care is committed to implementing all provisions of the health care reform law and working to create the healthiest communities in the nation.


  • Which services require prior authorization?

    Prior Authorization (PDF) View the list of services requiring prior authorization.


  • What is an Explanation of Benefits (EOB)?

    An EOB is a document to keep you informed of the health care claims that have been submitted on your behalf. You will receive an EOB after a claim for health care service has been received and processed. It shows what your health plan has paid to the provider, what the health plan has reimbursed to you (if applicable), any financial responsibility you may have for services provided, and if services were not paid for by your health plan. Please note, this is not a bill.

    You have the option to sign up to receive electronic EOBs, which means less mail from MVP delivered to your home. Once you sign up for eEOBs, you will receive an email notification when your Explanation of Benefits is available to view online instead of receiving the paper copy in the mail. This feature provides easier access to your documents when you need them, if you have access to a computer. The paperless option applies to EOB related to medical and dental claims only. To sign up, Sign In/Register to your MVP online account and select Claims Status & History under Your Plan.


  • What dental plan options are available through MVP Health Care?

    In New York, MVP offers Individual and Small Group pediatric dental plan options – as required by the Affordable Care Act (ACA) –as well as plans for adults. These plans are available as standalone dental options or alongside an MVP medical plan.

    Plus, 2019 MVP New York Small Group HMO, EPO/PPO, and MVP Vermont Individual and Small Group medical plans already include ACA-compliant pediatric dental benefits. Covered dependents, up to age 19 in New York, and up to age 21 in Vermont, have access to preventive, routine, and major services.

    Learn more about our dental plans.


Emergency and Coverage Away From Home

  • Am I covered by MVP when I am away from home?

    MVP members have 24-hour worldwide emergency coverage. If you have a medical emergency while you are outside the service area, you should seek care from the nearest doctor or hospital emergency room. Please let MVP know about the emergency within 48 hours, or as soon as physically possible.

    MVP reserves the right to retrospectively determine if the visit is of an emergency nature. In plain language, MVP can look at information from your emergency room visit after you are treated there and let you know that your care will not be covered as emergency care.

    Please view your plan materials or ask your employer for details about your emergency and non-emergency coverage, including deductibles or co-pays.


  • If I know I need care, but it's not really an emergency—what should I do?

    For medical help, you often have less expensive, more convenient options than the emergency room:

      • Call Your Doctor—many practices offer urgent appointments! Need a doctor? Use the Find a Doctor tool to locate one in your area.
      • Get Help From a Registered Nurse For Free—24 hours a day, 7 days a week. Call the MVP Customer Care Center phone number on the back of your MVP Member ID card, or sign in to your MVP member account to email us. Already logged in? Use our secure online form to get a response from a nurse within 24 hours.
      • Try an Urgent Care Center—If your doctor is not available, consider an urgent care center for sore throats, headaches, sprains or strains, minor cuts or burns, the flu and more—you will pay less (and usually wait less) than at the emergency room. Check our Find a Doctor tool for a list of in-network Urgent Care Centers near you.
      • myVisitNow® – eligible MVP members have access to “face-to-face” online video visits with urgent care doctors, within minutes, for non-emergency situations. Members can register at myvisitnow.com.

    If you think you need immediate life-saving care, you should go to the emergency room.

    If your employer’s plan provides benefits for covered dependents when they’re away at college, your children will be covered for sick care and emergencies—just as they would be when they’re at home.

    You may need to submit a Medical or Dental College Student Waiver Form and make sure that your children seek care from health care providers in MVP’s national network, depending on the details of your plan. Please look at your plan materials or ask your employer for more information. You can search for participating doctors, hospitals and labs, and pharmacies using the Find a Doctor tool.


  • Does MVP cover my kids when they’re away at college?

    If your employer’s plan provides benefits for covered dependents when they’re away at college, your children will be covered for sick care and emergencies—just as they would be when they’re at home.

    You may need to submit a Medical or Dental College Student Waiver Form and make sure that your children seek care from health care providers in MVP’s national network, depending on the details of your plan. Please look at your plan materials or ask your employer for more information. You can search for participating doctorshospitals and labs, and pharmacies.


Health Management Programs

  • What if I need a little extra help managing a medical condition?

    MVP offers free condition management programs that can help you better understand and treat a variety of medical conditions, such as asthma, diabetes, depression, heart disease, low back pain and more. We invite you to learn more, and contact us to see if you qualify.


Understanding Insurance

  • How can I get more information or answers to questions about my MVP health plan?

    Our Customer Care Center is available to answer your questions and help you better understand your MVP health plan. Visit the Contact Us page of our website or call the phone number on the back of your MVP Member ID card. You can also:

    • Send us an email. To make sure that your personal health information is safe, please use our secure email form to email the Customer Care Center.
    • Try our Live Chat feature.


  • If I get a bill for medical services that I don’t understand, what should I do?

    Please call the Customer Care Center using the phone number on the back of your MVP Member ID card if you have questions about a bill.


  • What is a high-deductible plan and how does it work?

    Click here for more information on high-deductible plans.


  • How can I get help to understand some of the health plan or medical words that I see in communications from MVP?

    Our online glossary includes definitions for a number of the most common health insurance terms or medical words you may find in a communication from MVP. You can also call the Customer Care Center using the phone number on the back of your MVP Member ID card for help understanding your benefits.


Prescription Benefits

  • What is a generic drug?

    A generic drug is a copy of a brand-name drug with the same active ingredients, dosage form, safety, strength, quality, and intended use. They are approved by the Food and Drug Administration and are typically sold at a lower cost. For example, ibuprofen is the generic for both Motrin® and Advil®.


  • What if my physician does not write the prescription so I can get a generic drug?

    While the use of generic drugs is encouraged to help you save money, you are not required to receive a generic drug. You will pay more for brand-name drugs when there is a generic equivalent available. Generally, generic drugs may be covered at your lowest tier co-payment. Brand-name drugs that have a generic equivalent may be covered at your highest tier co-payment or may not be covered.

    If your physician feels that a brand-name drug is the right choice for you, you will likely have a higher tier co-payment. If you receive a brand-name drug when there is a generic equivalent available, some of MVP’s prescription benefits may require you to pay the difference in cost between the generic and the brand-name drug, plus your Tier 1 co-payment.


  • Can I order prescriptions through the mail?

    If your benefit allows, medications that are taken on a regular basis, including contraceptives, thyroid medications, cholesterol and blood pressure medications, and many more, are available by mail order. CVS Caremark® is MVP’s contracted Pharmacy Benefit Manager and also our mail order pharmacy vendor.

    Using the mail order pharmacy lets you buy MVP-approved maintenance drugs in larger quantities and, at the same time, save trips to the pharmacy because prescriptions are delivered right to your door. Your co-pay for a 90-day supply of medication will generally be less than going to a retail pharmacy for the same amount of medication. You can refer to the MVP Formulary to identify which medications are available through your mail order benefit.


  • What is MVP’s Formulary?

    The Formulary is an extensive list of drugs, both generic and brand-name, that are covered by MVP for plans that offer prescription drug coverage. Each Formulary is a comprehensive guide that is developed based on sound clinical evidence and reflects current treatment guidelines and community practice standards.


  • Are there any additional requirements on prescription drugs?

    For certain prescription drugs, MVP Health Care has additional requirements for coverage or limits on our coverage. These requirements and limits ensure that our members use these drugs in the most effective way and also help us control drug plan costs. A team of doctors and pharmacists developed these requirements and limits for our health plans to help us provide quality coverage to our members. Certain drugs may need prior authorization, have a formulary exception, or require step therapy. Quantity limits may also apply. If you have questions on additional drug requirements, contact MVP using the phone number listed on the back of your MVP Member ID card.


  • Are my prescriptions covered by MVP?

    If you have prescription drug coverage with MVP, you are covered for all prescriptions on your plan’s approved list of medications. In cases where we do not cover a certain drug, we usually cover an alternative drug that does the same thing but may cost less. To find out if a specific drug is covered, review MVP’s Formularies online. This is a comprehensive list of generic and brand drugs covered by MVP Health Care plans that offer prescription drug coverage.

    The medication you need may require prior authorization or be subject to step therapy or quantity limits. This information can also be found on the Formularies. You may have a co-pay, co-insurance or deductible to pay out of your own pocket for prescriptions. Please look at your health plan materials.


  • How do I obtain specialty drugs?

    Some prescription drugs must be obtained through CVS Specialty. CVS Specialty handles high-touch, high-cost drugs for unique and complex medical conditions and delivers them to your doorstep. To find out if your drug is one of the drugs that must be obtained through CVS Specialty, please review the formulary for your prescription plan type.

    Note: MVP Medicaid Members may use CVS Specialty to obtain high-cost specialty drugs by mail. If you would prefer to obtain your specialty drugs at a local retail pharmacy, please call the pharmacy information number on the back of your ID card to get a listing of pharmacies in the MVP specialty network. Please note that prior authorization must be obtained, if required, prior to filling the specialty prescription at a network retail pharmacy or CVS Specialty.


  • How can I save money on my prescription drugs?

    Become a savvy consumer. Here are some tips to help you save money on your prescription drugs.