New York Small Group Platinum 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 Platinum 1 NY-EPO-SP-001 (2023) |
|
|---|---|
| State | New York |
| Plan Type | EPO |
| Exchange | Off |
| Metal Level | Platinum |
| Annual In-Network Deductible (Single/Family) | $0 / $0 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $2,450 / $4,900 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | $5 copay (First 3 Combined PCP, MH, SA Visits Covered in Full) |
| Specialist Visit | $45 copay |
| ER | $100 copay No Deductible. |
| Urgent Care | $45 copay No Deductible. |
| Generic Rx Coverage (Tier 1) | $5 copay No Deductible.30 day retail/90 day mail order |
| Preferred Rx Coverage (Tier 2) | $30 copay No Deductible.$100 max out of pocket on 30 day supply of Insulin |
| Non Preferred Rx Coverage (Tier 3) | $50 copay No Deductible.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 Platinum 3 NY-EPO-SP-003 (2023) |
|
|---|---|
| State | New York |
| Plan Type | EPO |
| Exchange | Off |
| Metal Level | Platinum |
| Annual In-Network Deductible (Single/Family) | $0 / $0 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $2,550 / $5,100 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | $30 copay |
| Specialist Visit | $50 copay |
| ER | $150 copay No Deductible. |
| Urgent Care | $50 copay No Deductible. |
| Generic Rx Coverage (Tier 1) | $5 copay No Deductible.30 day retail/90 day mail order |
| Preferred Rx Coverage (Tier 2) | $25 copay No Deductible.$100 max out of pocket on 30 day supply of Insulin |
| Non Preferred Rx Coverage (Tier 3) | $40 copay No Deductible.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 Platinum 5 NY-EPO-SP-005 (2023) |
|
|---|---|
| State | New York |
| Plan Type | EPO |
| Exchange | Off |
| Metal Level | Platinum |
| Annual In-Network Deductible (Single/Family) | $0 / $0 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $3,550 / $7,100 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | $15 copay |
| Specialist Visit | $25 copay |
| ER | $200 copay No Deductible. |
| Urgent Care | $25 copay No Deductible. |
| Generic Rx Coverage (Tier 1) | $10 copay No Deductible.30 day retail/90 day mail order |
| Preferred Rx Coverage (Tier 2) | $40 copay No Deductible.$100 max out of pocket on 30 day supply of Insulin |
| Non Preferred Rx Coverage (Tier 3) | $60 copay No Deductible.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 Platinum 2 NY-HMO-SP-002 (2023) |
|
|---|---|
| State | New York |
| Plan Type | HMO |
| Exchange | Off |
| Metal Level | Platinum |
| Annual In-Network Deductible (Single/Family) | $0 / $0 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $2,400 / $4,800 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | $10 copay |
| Specialist Visit | $35 copay |
| ER | $200 copay No Deductible. |
| Urgent Care | $35 copay No Deductible. |
| Generic Rx Coverage (Tier 1) | $5 copay No Deductible.30 day retail/90 day mail order |
| Preferred Rx Coverage (Tier 2) | $30 copay No Deductible.$100 max out of pocket on 30 day supply of Insulin |
| Non Preferred Rx Coverage (Tier 3) | $50 copay No Deductible.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 Platinum 6 NY-HMO-SP-006 (2023) |
|
|---|---|
| State | New York |
| Plan Type | HMO |
| Exchange | Off |
| Metal Level | Platinum |
| Annual In-Network Deductible (Single/Family) | $0 / $0 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $2,000 / $4,000 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | $15 copay |
| Specialist Visit | $35 copay |
| ER | $100 copay No Deductible. |
| Urgent Care | $35 copay No Deductible. |
| Generic Rx Coverage (Tier 1) | $10 copay No Deductible.30 day retail/90 day mail order |
| Preferred Rx Coverage (Tier 2) | $30 copay No Deductible.$100 max out of pocket on 30 day supply of Insulin |
| Non Preferred Rx Coverage (Tier 3) | $60 copay No Deductible.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 |