New York Small Group Bronze Plans
MVP Health Care non-standard plans for small businesses, part of MVP’s suite of Premier plans offered on New York State of Health.
MVP EPO Bronze 2 NY-EPO-SB-002 (2023) |
|
|---|---|
| State | New York |
| Plan Type | EPO |
| Exchange | Off |
| Metal Level | Bronze |
| Annual In-Network Deductible (Single/Family) | $6,000 / $12,000 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $8,400 / $16,800 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | $35 copay (First 3 Combined PCP, MH, SA Visits Covered in Full) |
| Specialist Visit | $60 copay |
| ER | $350 copay Deductible applies. |
| Urgent Care | $60 copay Deductible applies. |
| Generic Rx Coverage (Tier 1) | $10 copay Deductible applies. 30 day retail/90 day mail order |
| Preferred Rx Coverage (Tier 2) | $40 copay Deductible applies. $100 max out of pocket on 30 day supply of Insulin |
| Non Preferred Rx Coverage (Tier 3) | $60 copay Deductible applies. 30 day retail/90 day mail order |
| Rx Formulary | 2023 MVP Marketplace Formulary (PDF) |
| Rx Drug Search | Pharmacy Information for New York’s Prescription Drug Program |
| Find a Doctor | Doctor Search |
| Summary of Benefits and Coverage (SBC) | Click here to open detailed plan benefit information |
| Plan Overview | Click here to open the plan overview document |
| Plan Highlights | Cigna national network, pediatric dental, savings at preferred provider facilities, 20% discount on CVS brand health-related items |
| Well-Being Features | $600 Well-Being Reimbursement |
| Availability | January 1, 2023 |
MVP EPO Bronze 3 HDHP NY-EPOH-SB-003 (2023) |
|
|---|---|
| State | New York |
| Plan Type | EPO |
| Exchange | Off |
| Metal Level | Bronze |
| Annual In-Network Deductible (Single/Family) | $6,200 / $12,400 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $6,900 / $13,800 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | $30 copay |
| Specialist Visit | $50 copay |
| ER | $300 copay Deductible applies. |
| Urgent Care | $50 copay Deductible applies. |
| Generic Rx Coverage (Tier 1) | $10 copay Deductible applies. 30 day retail/90 day mail order; preventive drugs deductible waived |
| Preferred Rx Coverage (Tier 2) | $40 copay Deductible applies. $100 max out of pocket on 30 day supply of Insulin; preventive drugs deductible waived |
| Non Preferred Rx Coverage (Tier 3) | $60 copay Deductible applies. 30 day retail/90 day mail order; preventive drugs deductible waived |
| Rx Formulary | 2023 MVP Marketplace Formulary (PDF) |
| Rx Drug Search | Pharmacy Information for New York’s Prescription Drug Program |
| Find a Doctor | Doctor Search |
| Summary of Benefits and Coverage (SBC) | Click here to open detailed plan benefit information |
| Plan Overview | Click here to open the plan overview document |
| Plan Highlights | Cigna national network, pediatric dental, savings at preferred provider facilities, 20% discount on CVS brand health-related items |
| Well-Being Features | $600 Well-Being Reimbursement |
| Availability | January 1, 2023 |
MVP EPO Bronze 5 HDHP NY-EPOH-SB-005 (2023) |
|
|---|---|
| State | New York |
| Plan Type | EPO |
| Exchange | Off |
| Metal Level | Bronze |
| Annual In-Network Deductible (Single/Family) | $6,250 / $12,500 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $6,900 / $13,800 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | $5 copay |
| Specialist Visit | 50% coinsurance |
| ER | $100 copay Deductible applies. |
| Urgent Care | 50% coinsurance Deductible applies. |
| Generic Rx Coverage (Tier 1) | $5 copay Deductible applies. 30 day retail/90 day mail order; preventive drugs deductible waived |
| Preferred Rx Coverage (Tier 2) | $30 copay Deductible applies. $100 max out of pocket on 30 day supply of Insulin; preventive drugs deductible waived |
| Non Preferred Rx Coverage (Tier 3) | 50% coinsurance Deductible applies. 30 day retail/90 day mail order; preventive drugs deductible waived |
| Rx Formulary | 2023 MVP Marketplace Formulary (PDF) |
| Rx Drug Search | Pharmacy Information for New York’s Prescription Drug Program |
| Find a Doctor | Doctor Search |
| Summary of Benefits and Coverage (SBC) | Click here to open detailed plan benefit information |
| Plan Overview | Click here to open the plan overview document |
| Plan Highlights | Cigna national network, pediatric dental, savings at preferred provider facilities, 20% discount on CVS brand health-related items |
| Well-Being Features | $600 Well-Being Reimbursement |
| Availability | January 1, 2023 |
MVP EPO Bronze 6 HDHP NY-EPOH-SB-006 (2023) |
|
|---|---|
| State | New York |
| Plan Type | EPO |
| Exchange | Off |
| Metal Level | Bronze |
| Annual In-Network Deductible (Single/Family) | $6,900 / $13,800 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $6,900 / $13,800 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | 0% coinsurance |
| Specialist Visit | 0% coinsurance |
| ER | 0% coinsurance Deductible applies. |
| Urgent Care | 0% coinsurance Deductible applies. |
| Generic Rx Coverage (Tier 1) | 0% coinsurance Deductible applies. 30 day retail/90 day mail order; preventive drugs deductible waived |
| Preferred Rx Coverage (Tier 2) | 0% coinsurance Deductible applies. $100 max out of pocket on 30 day supply of Insulin; preventive drugs deductible waived |
| Non Preferred Rx Coverage (Tier 3) | 0% coinsurance Deductible applies. 30 day retail/90 day mail order; preventive drugs deductible waived |
| Rx Formulary | 2023 MVP Marketplace Formulary (PDF) |
| Rx Drug Search | Pharmacy Information for New York’s Prescription Drug Program |
| Find a Doctor | Doctor Search |
| Summary of Benefits and Coverage (SBC) | Click here to open detailed plan benefit information |
| Plan Overview | Click here to open the plan overview document |
| Plan Highlights | Cigna national network, pediatric dental, savings at preferred provider facilities, 20% discount on CVS brand health-related items |
| Well-Being Features | $600 Well-Being Reimbursement |
| Availability | January 1, 2023 |
MVP EPO Bronze 7 HDHP NY-EPOH-SB-007 (2023) |
|
|---|---|
| State | New York |
| Plan Type | EPO |
| Exchange | Off |
| Metal Level | Bronze |
| Annual In-Network Deductible (Single/Family) | $6,200 / $12,400 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $6,900 / $13,800 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | 40% coinsurance |
| Specialist Visit | 40% coinsurance |
| ER | 40% coinsurance Deductible applies. |
| Urgent Care | 40% coinsurance Deductible applies. |
| Generic Rx Coverage (Tier 1) | $10 copay Deductible applies. 30 day retail/90 day mail order; preventive drugs deductible waived |
| Preferred Rx Coverage (Tier 2) | $40 copay Deductible applies. $100 max out of pocket on 30 day supply of Insulin; preventive drugs deductible waived |
| Non Preferred Rx Coverage (Tier 3) | $60 copay Deductible applies. 30 day retail/90 day mail order; preventive drugs deductible waived |
| Rx Formulary | 2023 MVP Marketplace Formulary (PDF) |
| Rx Drug Search | Pharmacy Information for New York’s Prescription Drug Program |
| Find a Doctor | Doctor Search |
| Summary of Benefits and Coverage (SBC) | Click here to open detailed plan benefit information |
| Plan Overview | Click here to open the plan overview document |
| Plan Highlights | Cigna national network, pediatric dental, savings at preferred provider facilities, 20% discount on CVS brand health-related items |
| Well-Being Features | $600 Well-Being Reimbursement |
| Availability | January 1, 2023 |
MVP HMO Bronze 10 NY-HMO-SB-010 (2023) |
|
|---|---|
| State | New York |
| Plan Type | HMO |
| Exchange | Off |
| Metal Level | Bronze |
| Annual In-Network Deductible (Single/Family) | $9,100 / $18,200 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $9,100 / $18,200 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | $0 copay |
| Specialist Visit | $0 copay |
| ER | $0 copay Deductible applies. |
| Urgent Care | $0 copay Deductible applies. |
| Generic Rx Coverage (Tier 1) | $0 copay Deductible applies. 30 day retail/90 day mail order |
| Preferred Rx Coverage (Tier 2) | $0 copay Deductible applies. $100 max out of pocket on 30 day supply of Insulin |
| Non Preferred Rx Coverage (Tier 3) | $0 copay Deductible applies. 30 day retail/90 day mail order |
| Rx Formulary | 2023 MVP Marketplace Formulary (PDF) |
| Rx Drug Search | Pharmacy Information for New York’s Prescription Drug Program |
| Find a Doctor | Doctor Search |
| Summary of Benefits and Coverage (SBC) | Click here to open detailed plan benefit information |
| Plan Overview | Click here to open the plan overview document |
| Plan Highlights | Cigna national network, pediatric dental, savings at preferred provider facilities, 20% discount on CVS brand health-related items |
| Well-Being Features | $600 Well-Being Reimbursement |
| Availability | January 1, 2023 |
MVP HMO Bronze 2 NY-HMO-SB-002 (2023) |
|
|---|---|
| State | New York |
| Plan Type | HMO |
| Exchange | Off |
| Metal Level | Bronze |
| Annual In-Network Deductible (Single/Family) | $6,000 / $12,000 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $8,400 / $16,800 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | $35 copay (First 3 Combined PCP, MH, SA Visits Covered in Full) |
| Specialist Visit | $60 copay |
| ER | $350 copay Deductible applies. |
| Urgent Care | $60 copay Deductible applies. |
| Generic Rx Coverage (Tier 1) | $10 copay Deductible applies. 30 day retail/90 day mail order |
| Preferred Rx Coverage (Tier 2) | $40 copay Deductible applies. $100 max out of pocket on 30 day supply of Insulin |
| Non Preferred Rx Coverage (Tier 3) | $60 copay Deductible applies. 30 day retail/90 day mail order |
| Rx Formulary | 2023 MVP Marketplace Formulary (PDF) |
| Rx Drug Search | Pharmacy Information for New York’s Prescription Drug Program |
| Find a Doctor | Doctor Search |
| Summary of Benefits and Coverage (SBC) | Click here to open detailed plan benefit information |
| Plan Overview | Click here to open the plan overview document |
| Plan Highlights | Cigna national network, pediatric dental, savings at preferred provider facilities, 20% discount on CVS brand health-related items |
| Well-Being Features | $600 Well-Being Reimbursement |
| Availability | January 1, 2023 |
MVP HMO Bronze 9 HDHP NY-HMOH-SB-009 (2023) |
|
|---|---|
| State | New York |
| Plan Type | HMO |
| Exchange | Off |
| Metal Level | Bronze |
| Annual In-Network Deductible (Single/Family) | $6,100 / $12,200 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $6,900 / $13,800 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | 50% coinsurance |
| Specialist Visit | 50% coinsurance |
| ER | 50% coinsurance Deductible applies. |
| Urgent Care | 50% coinsurance Deductible applies. |
| Generic Rx Coverage (Tier 1) | $10 copay Deductible applies. 30 day retail/90 day mail order; preventive drugs deductible waived |
| Preferred Rx Coverage (Tier 2) | $35 copay Deductible applies. $100 max out of pocket on 30 day supply of Insulin; preventive drugs deductible waived |
| Non Preferred Rx Coverage (Tier 3) | $70 copay Deductible applies. 30 day retail/90 day mail order; preventive drugs deductible waived |
| Rx Formulary | 2023 MVP Marketplace Formulary (PDF) |
| Rx Drug Search | Pharmacy Information for New York’s Prescription Drug Program |
| Find a Doctor | Doctor Search |
| Summary of Benefits and Coverage (SBC) | Click here to open detailed plan benefit information |
| Plan Overview | Click here to open the plan overview document |
| Plan Highlights | Cigna national network, pediatric dental, savings at preferred provider facilities, 20% discount on CVS brand health-related items |
| Well-Being Features | $600 Well-Being Reimbursement |
| Availability | January 1, 2023 |