Understand how health insurance works.
MVP offers health plans in New York and Vermont for individuals, employers, Medicare, and more. And we know it can get confusing sometimes. So we’re here to help. Because the more you understand about health insurance, the better prepared you’ll be to make smart choices about your health care.
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.
How do I select/change my PCP?
Simply Sign In to your member account at mvphealthcare.com to select or change your PCP or call the MVP Customer Care Center at the phone number on the back of your Member ID card.
Primary care is the first place you go for routine health care. A PCP helps you access a range of health services. If you need specialized care, you may see a health provider who focuses on a certain area of medicine, and your PCP usually works within a network of participating providers to coordinate your care. With the Find a Doctor tool, you can easily search for participating doctors, hospitals, labs, and pharmacies. Simply visit mvphealthcare.com > Find a Doctor, and begin searching, or use your myMVP mobile app.
Am I covered when traveling?
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 look at your plan materials or ask your employer for details about your emergency coverage, including deductibles or co-pays.
For non-emergency medical needs when you are traveling outside the MVP service area, please call the MVP Customer Care Center at the phone number on the back of your Member ID card.
What is the difference between brand-name drugs and generic drugs?
A generic drug has the same active-ingredient formula as a brand-name drug. To make it to market, a generic drug must be approved by strict standards from the FDA. And, generic drugs usually cost less than brand-name drugs.
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. This is called the Brand/Generic Difference. In this case, you must pay the difference between the cost of the more expensive drug over the less expensive drug, plus your co-payment or co-insurance. In the event that a brand name drug is requested over a generic drug and is determined by MVP to be medically necessary, you will not be required to pay the difference. (Note: the Brand/Generic Difference program is not available to all groups. Exceptions do apply.) For more information, Sign In at mvphealthcare.com and choose Pharmacy (CVS Caremark).
What is a high-deductible health plan?
High-deductible health plans (HDHPs) have higher deductibles and lower monthly premiums compared to traditional plans. If your plan has a high-deductible, you will pay the full cost for health services you use until the deductible is met. After the deductible is met, the plan begins to pay for some (or all) of your costs. With an HDHP, you may have higher costs when you use health care, but you’ll pay less for insurance on a monthly basis. In addition, HDHPs can be paired with an HSA or HRA. These accounts allow you to save for current and future health expenses. Learn more about HDHP’s.
Questions on financial assistance?
Learn what programs you might be eligible for.
HDHP Cost Calculator
Use our helpful online tool to compare plans and deductibles, estimate costs and calculate overall savings.