New York Small Group Silver 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 Silver 2 NY-EPO-SS-002 (2023) |
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State | New York |
Plan Type | EPO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $4,500 / $9,000 |
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 waived. |
Generic Rx Coverage (Tier 1) | $10 copay Deductible applies. 30 day retail/90 day mail order |
Preferred Rx Coverage (Tier 2) | $45 copay Deductible applies. $100 max out of pocket on 30 day supply of Insulin |
Non Preferred Rx Coverage (Tier 3) | $90 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 Silver 3 HDHP NY-EPOH-SS-003 (2023) |
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---|---|
State | New York |
Plan Type | EPO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $2,500 / $5,000 |
Annual Out-of-Network Deductible | N/A |
Annual In-Network Out-of-Pocket Limit (Single/Family) | $5,900 / $11,800 |
Annual Out-of-Network Out-of-Pocket Limit | N/A |
Primary Care Visit | $25 copay |
Specialist Visit | $50 copay |
ER | $300 copay Deductible applies. |
Urgent Care | $50 copay Deductible applies. |
Generic Rx Coverage (Tier 1) | $15 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 Silver 4 with HRA NY-EPO-SS-004 (2023) |
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---|---|
State | New York |
Plan Type | EPO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $2,800 / $5,600 |
Annual Out-of-Network Deductible | N/A |
Annual In-Network Out-of-Pocket Limit (Single/Family) | $6,600 / $13,200 |
Annual Out-of-Network Out-of-Pocket Limit | N/A |
Primary Care Visit | $20 copay |
Specialist Visit | $50 copay |
ER | $300 copay Deductible applies. |
Urgent Care | $50 copay Deductible applies. |
Generic Rx Coverage (Tier 1) | $15 copay Deductible waived. 30 day retail/90 day mail order |
Preferred Rx Coverage (Tier 2) | $40 copay Deductible waived. $100 max out of pocket on 30 day supply of Insulin |
Non Preferred Rx Coverage (Tier 3) | 50% coinsurance Deductible waived. 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 Silver 7 NY-EPO-SS-007 (2023) |
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---|---|
State | New York |
Plan Type | EPO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $3,000 / $6,000 |
Annual Out-of-Network Deductible | N/A |
Annual In-Network Out-of-Pocket Limit (Single/Family) | $8,700 / $17,400 |
Annual Out-of-Network Out-of-Pocket Limit | N/A |
Primary Care Visit | $30 copay |
Specialist Visit | $50 copay |
ER | $250 copay Deductible applies. |
Urgent Care | $50 copay Deductible waived. |
Generic Rx Coverage (Tier 1) | $15 copay Deductible waived. 30 day retail/90 day mail order |
Preferred Rx Coverage (Tier 2) | $45 copay Deductible waived. $100 max out of pocket on 30 day supply of Insulin |
Non Preferred Rx Coverage (Tier 3) | $90 copay Deductible waived. 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 Silver 8 HDHP NY-EPOH-SS-008 (2023) |
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---|---|
State | New York |
Plan Type | EPO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $4,400 / $8,800 |
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 copay |
Specialist Visit | $0 copay |
ER | $0 copay Deductible applies. |
Urgent Care | $0 copay Deductible applies. |
Generic Rx Coverage (Tier 1) | $15 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 Silver 12 NY-HMO-SS-012 (2023) |
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---|---|
State | New York |
Plan Type | HMO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $1,850 / $3,700 |
Annual Out-of-Network Deductible | N/A |
Annual In-Network Out-of-Pocket Limit (Single/Family) | $8,200 / $16,400 |
Annual Out-of-Network Out-of-Pocket Limit | N/A |
Primary Care Visit | $30 copay |
Specialist Visit | $50 copay |
ER | $250 copay Deductible applies. |
Urgent Care | $50 copay Deductible applies. |
Generic Rx Coverage (Tier 1) | $10 copay No Deductible.30 day retail/90 day mail order |
Preferred Rx Coverage (Tier 2) | $35 copay No Deductible.$100 max out of pocket on 30 day supply of Insulin |
Non Preferred Rx Coverage (Tier 3) | $70 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 Silver 13 NY-HMO-SS-013 (2023) |
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---|---|
State | New York |
Plan Type | HMO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $3,400 / $6,800 |
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 | $35 copay ($0 copay to age 26) |
Specialist Visit | $50 copay |
ER | $275 copay Deductible applies. |
Urgent Care | $50 copay Deductible waived. |
Generic Rx Coverage (Tier 1) | $15 copay Deductible waived. $0 copay to age 26; 30 day retail/90 day mail order |
Preferred Rx Coverage (Tier 2) | $45 copay Deductible applies. $100 max out of pocket on 30 day supply of Insulin |
Non Preferred Rx Coverage (Tier 3) | $90 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 Silver 3 HDHP NY-HMOH-SS-003 (2023) |
|
---|---|
State | New York |
Plan Type | HMO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $2,500 / $5,000 |
Annual Out-of-Network Deductible | N/A |
Annual In-Network Out-of-Pocket Limit (Single/Family) | $5,900 / $11,800 |
Annual Out-of-Network Out-of-Pocket Limit | N/A |
Primary Care Visit | $25 copay |
Specialist Visit | $50 copay |
ER | $300 copay Deductible applies. |
Urgent Care | $50 copay Deductible applies. |
Generic Rx Coverage (Tier 1) | $15 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 |