Standard Individual Gold Plans

MVP Health Care standard individual gold 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 Gold 1 FRNY-HMO-DG-001-S (2021)

State New York
Plan Type HMO
Exchange On
Metal Level Gold
Annual In-Network Deductible (Single/Family) $600 / $1,200
Annual Out-of-Network Deductible N/A
Annual In-Network Out-of-Pocket Limit (Single/Family) $4,000 / $8,000
Annual Out-of-Network Out-of-Pocket Limit N/A
Primary Care Visit $25 copay
Specialist Visit $40 copay
ER $150 copay Deductible applies.
Urgent Care $60 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.
Non Preferred Rx Coverage (Tier 3) $70 copay Deductible waived. 30 day retail/90 day mail order.
Rx Formulary 2021 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 $0 telemedicine services, 20% discount on CVS health brand-related items
Well-Being Features $600 WellBeing Rewards
Availability January 1, 2021

MVP Premier Gold 1 AI-AN FRNY-HMO-DGA1-001-S (2021)

State New York
Plan Type HMO
Exchange On
Metal Level Gold
Annual In-Network Deductible (Single/Family) $0 / $0
Annual Out-of-Network Deductible N/A
Annual In-Network Out-of-Pocket Limit N/A
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.
Non Preferred Rx Coverage (Tier 3) $0 copay No Deductible. 30 day retail/90 day mail order.
Rx Formulary 2021 MVP Marketplace Formulary (PDF)
Rx Drug Search Pharmacy Information for New York’s Prescription Drug Program
Special EligibilityAmerican 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 $0 telemedicine services, 20% discount on CVS health brand-related items
Well-Being Features $600 WellBeing Rewards
Availability January 1, 2021