Standard Individual Bronze Plans
MVP Health Care standard individual bronze plans, part of MVP's suite of Premier plans offered on New York State of Health.
View all MVP NY Individual & Family Plans
MVP Premier Bronze 1 HDHP FRNY-HMOH-DB-001-S (2022) |
|
|---|---|
| State | New York |
| Plan Type | HMO |
| Exchange | On |
| 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. |
| 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 | 20% discount on CVS brand health-related items |
| Well-Being Features | $600 WellBeing Rewards |
| Availability | January 1, 2022 |
MVP Premier Bronze 2 FRNY-HMO-DB-002-S (2022) |
|
|---|---|
| State | New York |
| Plan Type | HMO |
| Exchange | On |
| Metal Level | Bronze |
| Annual In-Network Deductible (Single/Family) | $4,700 / $9,400 |
| 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 | $50 copay (First 3 visits no Deductible) |
| Specialist Visit | $75 copay (First 3 visits no Deductible) |
| ER | $500 copay Deductible applies. |
| Urgent Care | $75 copay Deductible applies. |
| Generic Rx Coverage (Tier 1) | $10 copay Deductible applies. 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 | 20% discount on CVS brand health-related items |
| Well-Being Features | $600 WellBeing Rewards |
| Availability | January 1, 2022 |
MVP Premier Bronze 1 AI-AN FRNY-HMOH-DBA1-001-S (2022) |
|
|---|---|
| State | New York |
| Plan Type | HMO |
| Exchange | On |
| Metal Level | Bronze |
| Annual In-Network Deductible (Single/Family) | $0 / $0 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $0 / $0 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | $0 copay |
| Specialist Visit | $0 copay |
| ER | $0 copay No Deductible. |
| Urgent Care | $0 copay No Deductible. |
| Generic Rx Coverage (Tier 1) | $0 copay No Deductible. 30 day retail/90 day mail order. |
| Preferred Rx Coverage (Tier 2) | $0 copay No Deductible. 30 day retail/90 day mail order. $100 max out of pocket on 30 day supply of Insulin |
| Non Preferred Rx Coverage (Tier 3) | $0 copay No Deductible. 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 |
| Special Eligibility | American Indian/Alaska Native |
| 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 | 20% discount on CVS brand health-related items |
| Well-Being Features | $600 WellBeing Rewards |
| Availability | January 1, 2022 |
MVP Premier Bronze 2 AI-AN FRNY-HMO-DBA1-002-S (2022) |
|
|---|---|
| State | New York |
| Plan Type | HMO |
| Exchange | On |
| Metal Level | Bronze |
| Annual In-Network Deductible (Single/Family) | $0 / $0 |
| Annual Out-of-Network Deductible | N/A |
| Annual In-Network Out-of-Pocket Limit (Single/Family) | $0 / $0 |
| Annual Out-of-Network Out-of-Pocket Limit | N/A |
| Primary Care Visit | $0 copay |
| Specialist Visit | $0 copay |
| ER | $0 copay No Deductible. |
| Urgent Care | $0 copay No Deductible. |
| Generic Rx Coverage (Tier 1) | $0 copay No Deductible. 30 day retail/90 day mail order. |
| Preferred Rx Coverage (Tier 2) | $0 copay No Deductible. 30 day retail/90 day mail order. $100 max out of pocket on 30 day supply of Insulin |
| Non Preferred Rx Coverage (Tier 3) | $0 copay No Deductible. 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 |
| Special Eligibility | American Indian/Alaska Native |
| 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 | 20% discount on CVS brand health-related items |
| Well-Being Features | $600 WellBeing Rewards |
| Availability | January 1, 2022 |