Standard Individual Platinum Plans

MVP Health Care standard individual platinum 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 Platinum 1 FRNY-HMO-DP-001-S (2022)

State New York
Plan Type HMO
Exchange On
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 $55 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. 30 day retail/90 day mail order. $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 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 Platinum 1 AI-AN FRNY-HMO-DPA1-001-S (2022)

State New York
Plan Type HMO
Exchange On
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) $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 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 20% discount on CVS brand health-related items
Well-Being Features $600 WellBeing Rewards
Availability January 1, 2022