Standard Individual Silver Plans

MVP Health Care standard individual silver 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 Silver 1 FRNY-HMO-DS-001-S (2023)

State New York
Plan Type HMO
Exchange On
Metal Level Silver
Annual In-Network Deductible (Single/Family) $1,750 / $3,500
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 $30 copay (First visit for either PCP, MH, SA, or SP before DD)
Specialist Visit $65 copay (First visit for either PCP, MH, SA, or SP before DD)
ER $500 copay Deductible applies.
Urgent Care $70 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) $75 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 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 Premier Silver 1 73 FRNY-HMO-DS1-001-S-73 (2023)

State New York
Plan Type HMO
Exchange On
Metal Level Silver
Annual In-Network Deductible (Single/Family) $1,625 / $3,250
Annual Out-of-Network Deductible N/A
Annual In-Network Out-of-Pocket Limit (Single/Family) $7,250 / $14,500
Annual Out-of-Network Out-of-Pocket Limit N/A
Primary Care Visit $30 copay (First visit for either PCP, MH, SA, or SP before DD)
Specialist Visit $65 copay (First visit for either PCP, MH, SA, or SP before DD)
ER $275 copay Deductible applies.
Urgent Care $70 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) $75 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
Special EligibilityMust qualify for Cost-Saving Reduction (CSR)
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 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 Premier Silver 1 87 FRNY-HMO-DS1-001-S-87 (2023)

State New York
Plan Type HMO
Exchange On
Metal Level Silver
Annual In-Network Deductible (Single/Family) $250 / $500
Annual Out-of-Network Deductible N/A
Annual In-Network Out-of-Pocket Limit (Single/Family) $2,800 / $5,600
Annual Out-of-Network Out-of-Pocket Limit N/A
Primary Care Visit $15 copay (First visit for either PCP, MH, SA, or SP before DD)
Specialist Visit $35 copay (First visit for either PCP, MH, SA, or SP before DD)
ER $75 copay Deductible applies.
Urgent Care $50 copay Deductible applies.
Generic Rx Coverage (Tier 1) $9 copay Deductible waived. 30 day retail/90 day mail order
Preferred Rx Coverage (Tier 2) $20 copay Deductible waived. $100 max out of pocket on 30 day supply of Insulin
Non Preferred Rx Coverage (Tier 3) $40 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
Special EligibilityMust qualify for Cost-Saving Reduction (CSR)
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 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 Premier Silver 1 94 FRNY-HMO-DS1-001-S-94 (2023)

State New York
Plan Type HMO
Exchange On
Metal Level Silver
Annual In-Network Deductible (Single/Family) $0 / $0
Annual Out-of-Network Deductible N/A
Annual In-Network Out-of-Pocket Limit (Single/Family) $1,000 / $2,000
Annual Out-of-Network Out-of-Pocket Limit N/A
Primary Care Visit $10 copay
Specialist Visit $20 copay
ER $50 copay No Deductible.
Urgent Care $30 copay No Deductible.
Generic Rx Coverage (Tier 1) $6 copay No Deductible.30 day retail/90 day mail order
Preferred Rx Coverage (Tier 2) $15 copay No Deductible.$100 max out of pocket on 30 day supply of Insulin
Non Preferred Rx Coverage (Tier 3) $30 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
Special EligibilityMust qualify for Cost-Saving Reduction (CSR)
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 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 Premier Silver 1 AI-AN FRNY-HMO-DSA1-001-S (2023)

State New York
Plan Type HMO
Exchange On
Metal Level Silver
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.$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 2023 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 Savings at preferred provider facilities, 20% discount on CVS brand health-related items
Well-Being Features $600 Well-Being Reimbursement
Availability January 1, 2023