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 1 NY-EPO-SS-001 (2022) |
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State | New York |
Plan Type | EPO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $2,100 / $4,200 |
Annual Out-of-Network Deductible | N/A |
Annual In-Network Out-of-Pocket Limit (Single/Family) | $7,800 / $15,600 |
Annual Out-of-Network Out-of-Pocket Limit | N/A |
Primary Care Visit | $30 copay |
Specialist Visit | $50 copay |
ER | $350 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) | $35 copay Deductible applies. 30 day retail/90 day mail order. $100 max out of pocket on 30 day supply of Insulin |
Non Preferred Rx Coverage (Tier 3) | $70 copay Deductible applies. 30 day retail/90 day mail order. |
Rx Formulary | 2022 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 WellBeing Rewards |
Availability | January 1, 2022 |
MVP EPO Silver 2 NY-EPO-SS-002 (2022) |
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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 ($0 copay first 3 visits) |
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. 30 day retail/90 day mail order. $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 | 2022 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 WellBeing Rewards |
Availability | January 1, 2022 |
MVP EPO Silver 3 HDHP NY-EPOH-SS-003 (2022) |
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---|---|
State | New York |
Plan Type | EPO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $2,200 / $4,400 |
Annual Out-of-Network Deductible | N/A |
Annual In-Network Out-of-Pocket Limit (Single/Family) | $5,200 / $10,400 |
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. 30 day retail/90 day mail order.; $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 | 2022 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 WellBeing Rewards |
Availability | January 1, 2022 |
MVP EPO Silver 4 with HRA NY-EPO-SS-004 (2022) |
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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) | $6,350 / $12,700 |
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) | $10 copay Deductible waived. 30 day retail/90 day mail order. |
Preferred Rx Coverage (Tier 2) | $35 copay Deductible waived. 30 day retail/90 day mail order.; $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 | 2022 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 WellBeing Rewards |
Availability | January 1, 2022 |
MVP EPO Silver 7 NY-EPO-SS-007 (2022) |
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---|---|
State | New York |
Plan Type | EPO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $3,100 / $6,200 |
Annual Out-of-Network Deductible | N/A |
Annual In-Network Out-of-Pocket Limit (Single/Family) | $8,000 / $16,000 |
Annual Out-of-Network Out-of-Pocket Limit | N/A |
Primary Care Visit | $30 copay |
Specialist Visit | $40 copay |
ER | $200 copay Deductible applies. |
Urgent Care | $40 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. 30 day retail/90 day mail order.; $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 | 2022 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 WellBeing Rewards |
Availability | January 1, 2022 |
MVP EPO Silver 8 HDHP NY-EPOH-SS-008 (2022) |
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---|---|
State | New York |
Plan Type | EPO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $3,900 / $7,800 |
Annual Out-of-Network Deductible | N/A |
Annual In-Network Out-of-Pocket Limit (Single/Family) | $6,000 / $12,000 |
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. 30 day retail/90 day mail order.; $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 | 2022 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 WellBeing Rewards |
Availability | January 1, 2022 |
MVP HMO Silver 12 NY-HMO-SS-012 (2022) |
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---|---|
State | New York |
Plan Type | HMO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $1,700 / $3,400 |
Annual Out-of-Network Deductible | N/A |
Annual In-Network Out-of-Pocket Limit (Single/Family) | $7,900 / $15,800 |
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 Deductible waived. 30 day retail/90 day mail order. |
Preferred Rx Coverage (Tier 2) | $35 copay Deductible waived. 30 day retail/90 day mail order. $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 | 2022 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 | Pediatric dental, savings at preferred provider facilities, 20% discount on CVS brand health-related items |
Well-Being Features | $600 WellBeing Rewards |
Availability | January 1, 2022 |
MVP HMO Silver 13 NY-HMO-SS-013 (2022) |
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---|---|
State | New York |
Plan Type | HMO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $2,850 / $5,700 |
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 | $35 copay ($0 copay to age 26) |
Specialist Visit | $50 copay |
ER | $250 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. 30 day retail/90 day mail order. $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 | 2022 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 | Pediatric dental, savings at preferred provider facilities, 20% discount on CVS brand health-related items |
Well-Being Features | $600 WellBeing Rewards |
Availability | January 1, 2022 |
MVP HMO Silver 3 HDHP NY-HMOH-SS-003 (2022) |
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---|---|
State | New York |
Plan Type | HMO |
Exchange | Off |
Metal Level | Silver |
Annual In-Network Deductible (Single/Family) | $2,200 / $4,400 |
Annual Out-of-Network Deductible | N/A |
Annual In-Network Out-of-Pocket Limit (Single/Family) | $5,200 / $10,400 |
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. 30 day retail/90 day mail order.; $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 | 2022 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 | Pediatric dental, savings at preferred provider facilities, 20% discount on CVS brand health-related items |
Well-Being Features | $600 WellBeing Rewards |
Availability | January 1, 2022 |