Find key documents and additional information to help you manage your plan. The documents and notices below are organized by plan type and region/coverage area.

  • Medicare Advantage
  • UVM Health Advantage
  • DualAccess
  • Individual & Family
  • Small Group Employer

2024 Plan Documents

Benefits at a Glance

Annual Notice of Coverage (ANOC)

Evidence of Coverage (EOC)

Summary of Benefits (SB)

Capital District, Southern Tier, Hudson Valley, Central New York

Capital District, Southern Tier, Hudson Valley, Central New York, Vermont

Hudson Valley

Rochester and Buffalo

UVM Health Advantage

Medicare Pharmacy Information

Medicare Star Rating

2023 Plan Documents

Benefits at a Glance

Annual Notice of Coverage (ANOC)

All Regions

Capital District, Southern Tier, Hudson Valley, Central New York

Capital District, Southern Tier, Hudson Valley, Central New York, Vermont

East Region

Hudson Valley

Rochester and Buffalo

Evidence of Coverage (EOC)

Summary of Benefits (SB)

All Regions

Capital District, Southern Tier, Hudson Valley, Central New York

Capital District, Southern Tier, Hudson Valley, Central New York, Vermont

Hudson Valley

Rochester and Buffalo

Medicare Pharmacy Information

Medicare Star Rating

2024 Plan Documents

2023 Plan Documents

New York 


Standard Individual Plans – Product Description/Summary of Benefits
 

 Platinum

Summary of Benefits and Coverage (SBC)
Plan Overview   

Gold 
Summary of Benefits and Coverage (SBC)
Plan Overview 
Silver  Summary of Benefits and Coverage (SBC)
Plan Overview  
Bronze  Summary of Benefits and Coverage (SBC)
Plan Overview  
Catastrophic  Summary of Benefits and Coverage (SBC)
Plan Overview  
  


Non-Standard Individual Plans – Product Description/Summary of Benefits 

 

Platinum 

Summary of Benefits and Coverage (SBC)  

Plan Overview

Gold  Summary of Benefits and Coverage (SBC)

Plan Overview 

Silver  Summary of Benefits and Coverage (SBC)

Plan Overview 

Bronze  Summary of Benefits and Coverage (SBC)

Plan Overview 

 

 

Vermont 

MVP Health Plan, Inc. is an HMO-POS/PPO/HMO D-SNP organization with a Medicare contract and a contract with the New York State Medicaid program. Enrollment in MVP Health Plan depends on contract renewal. MVP Health Plan, Inc. has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 12/31/2024 based on review of MVP Health Plan’s Model of Care. Health benefit plans are issued by MVP Health Plan, Inc., an operating subsidiary of MVP Health Care, Inc. Not all plans available in all states and counties. Every year, Medicare evaluates plans based on a 5-star rating system. Out-of-network/non-contracted providers are under no obligation to treat MVP Health Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. For accommodationsofpersons with special needs at meetings, call 1-800-324-3899 (TTY 711).
Other physicians/providers are available in the MVP Health Care network. Gia virtual care services are available at no member cost-share for medical plans, including qualified high-deductible health plans (QHDHPs). Exceptions may apply for self-funded plans. In-person visits and referrals are subject to cost-share per plan. Members enrolled in a Medicare Rx plan without additional MVP medical coverage do not have access to MVP virtual care services through Gia. SilverSneakers is a registered trademark of Tivity Health, Inc. SilverSneakers On-Demand is a trademark of Tivity Health, Inc. ©2023 Tivity Health, Inc. All rights reserved. GetSetUp is a third-party provider and is not owned or operated by Tivity Health, Inc. (“Tivity”) or its affiliates. Users must have internet service to access online services. Internet service charges are responsibility of user.
TruHearing® and (RE)TM are trademarks of TruHearing, Inc. All other trademarks, product names, and company names are the property of their respective owners. Retail pricing based on prices for comparable aids. Follow-up provider visits included for one year following hearing aid purchase. Free battery offer is not applicable to the purchase of rechargeable hearing aid models. Three-year warranty includes repairs and one-time loss and damage replacement. Hearing aid repairs and replacements are subject to provider and manufacturer fees. For questions regarding fees, contact a TruHearing hearing consultant.
©2023 NationsBenefits, LLC. and NationsOTC, LLC. NationsOTC is a registered trademark of NationsOTC, LLC. All other marks are the property of their respective owners. Mom’s Meals® is a registered trademark of PurFoods, Inc.
Y0051_9080_M | Last Updated: 10/1/2023