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.
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Medicare – NY
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UVM Health Advantage
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Individual & Family – NY & VT
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Small Group Employer – NY & VT
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
- Medicare WellSelect with Part D (PPO)
- Medicare WellSelect Plus with Part D (PPO)
- MVP Medicare WellSelect® with Part D (PPO)(Spanish)
- MVP Medicare WellSelect® Plus with Part D (PPO) (Spanish)
Rochester and Buffalo
- Medicare Preferred Gold without Part D (HMO-POS)
- Medicare Preferred Gold with Part D (HMO-POS)
- Medicare Secure with Part D (HMO-POS)
- Medicare WellSelect with Part D (PPO)
Dual Special Needs Program (D-SNP)
Evidence of Coverage (EOC)
Capital District, Southern Tier, Central New York
Capital District, Southern Tier, Hudson Valley, Central New York
Capital District, Southern Tier, Hudson Valley, Central New York, Vermont
Hudson Valley
- Medicare WellSelect with Part D
- MVP Medicare WellSelect with Part D (PPO) (Spanish)
- Medicare WellSelect Plus with Part D
- MVP Medicare WellSelect Plus with Part D (PPO)(Spanish)
Rochester and Buffalo
- Medicare Patriot Plan
- Medicare Preferred Gold without Part D
- Medicare Preferred Gold with Part D;
- Medicare Secure with Part D
- Medicare WellSelect with Part D
Dual Special Needs Program (D-SNP)
Summary of Benefits (SOB)
All Regions
Capital District, Southern Tier, Hudson Valley, Central New York
- Medicare Secure with Part D (HMO-POS), Medicare Preferred Gold with Part D (HMO-POS)
- Medicare WellSelect Plus with Part D (PPO)
Capital District, Southern Tier, Hudson Valley, Central New York, Vermont
- Medicare Secure Plus with Part D (HMO-POS), Medicare Preferred Gold without Part D (HMO-POS
- Medicare WellSelect with Part D (PPO)
Hudson Valley
- Medicare WellSelect with Part D (PPO), Medicare WellSelect Plus with Part D (PPO)
- MVP® Medicare WellSelect® with Part D (PPO) and MVP® Medicare WellSelect® Plus with Part D (PPO) (Spanish)
Rochester and Buffalo
- Medicare Secure with Part D (HMO-POS), Medicare Preferred Gold with Part D (HMO-POS) and Medicare Preferred Gold without Part D (HMO-POS)
- Medicare WellSelect with Part D (PPO)
Dual Special Needs Program (D-SNP)
Provider Directory
All Regions
Central
Capital District
Hudson Valley
Rochester, Southern Tier
Vermont, Northern New York
LIS Premium Grid
- LIS Premium Grid – Vermont, Northern New York
- LIS Premium Grid – Hudson Valley
- LIS Premium Grid – Hudson Valley (Spanish)
- LIS Premium Grid – Capital District, Central New York, Southern Tier
- LIS Premium Grid – Buffalo, Rochester
Medicare Star Rating
All Regions
Annual Notice of Changes (ANOC)
Evidence of Coverage (EOC)
Summary of Benefits (SOB)
Provider Directory
LIS Premium Grid
Medicare Star Rating
All Regions
New York
Standard Individual Plans – Product Description/Summary of Benefits
Non-Standard Individual Plans – Product Description/Summary of Benefits
| Platinum | |
| Gold | Summary of Benefits and Coverage (SBC) |
| Silver | Summary of Benefits and Coverage (SBC) |
| Bronze | Summary of Benefits and Coverage (SBC) |
Vermont
- MVP VT Bronze 2
- MVP VT Bronze 2 AI-AN
- MVP VT Bronze 3 AI-AN U300
- MVP VT Bronze 3 HDHP
- MVP VT Bronze 3 HDHP AI-AN
- MVP VT Bronze 4 AI-AN U300
- MVP VT Bronze 4 AI-AN
- MVP VT Bronze 4
- MVP VT Gold 1 AI-AN U300
- MVP VT Gold 1 AI-AN
- MVP VT Gold 1
- MVP VT Platinum 1
- MVP VT Platinum 1 AI-AN
- MVP VT Platinum 1 AI-AN U300
- MVP VT Plus AIAN U300
- MVP VT Plus Bronze 1 AI-AN
- MVP VT Plus Bronze 1 AI-AN U300
- MVP VT Plus Bronze 1
- MVP VT Plus Bronze 5
- MVP VT Plus Bronze 5 AI-AN
- MVP VT Plus Bronze 5 AI-AN U300
- MVP VT Plus Gold 2
- MVP VT Plus Gold 2 AI-AN
- MVP VT Plus Gold 2 AI-AN U300
- MVP VT Plus Gold 3 AI-AN U300
- MVP VT Plus Gold 3 HDHP
- MVP VT Plus Gold 3 HDHP AI-AN
- MVP VT Plus Reflective Silver 1
- MVP VT Plus Reflective Silver 2 HDHP
- MVP VT Plus Silver 1
- MVP VT Plus Silver 1 73
- MVP VT Plus Silver 1 77
- MVP VT Plus Silver 1 87
- MVP VT Plus Silver 1 94
- MVP VT Plus Silver 1 AI-AN
- MVP VT Plus Silver 1 AI-AN U300
- MVP VT Plus Silver 2 94
- MVP VT Plus Silver 2 AI-AN U300
- MVP VT Plus Silver 2 HDHP
- MVP VT Plus Silver 2 HDHP 77
- MVP VT Plus Silver 2 HDHP 87
- MVP VT Plus Silver 2 HDHP AI-AN
- MVP VT Plus Silver 2 HDHP CSR 73
- MVP VT Reflective Silver 3
- MVP VT Reflective Silver 4 HDHP
- MVP VT Secure
- MVP VT Silver 3
- MVP VT Silver 3 73
- MVP VT Silver 3 77
- MVP VT Silver 3 87
- MVP VT Silver 3 94
- MVP VT Silver 3 AI-AN
- MVP VT Silver 3 AI-AN U300
- MVP VT Silver 4 94
- MVP VT Silver 4 AI-AN U300
- MVP VT Silver 4 HDHP
- MVP VT Silver 4 HDHP 73
- MVP VT Silver 4 HDHP 77
- MVP VT Silver 4 HDHP 87
- MVP VT Silver 4 HDHP AI-AN
New York
Small Group EPO – Product Description/Summary of Benefits
| Platinum | Summary of Benefits and Coverage (SBC) |
| Gold | Summary of Benefits and Coverage (SBC) |
| Silver | Summary of Benefits and Coverage (SBC) |
| Bronze | Summary of Benefits and Coverage (SBC) |
Small Group HMO – Product Description/Summary of Benefits
| Platinum | Summary of Benefits and Coverage (SBC) |
| Gold | Summary of Benefits and Coverage (SBC) |
| Silver | Summary of Benefits and Coverage (SBC) |
| Bronze | Summary of Benefits and Coverage (SBC) |
Vermont
- SG - MVP VT Bronze 2
- SG - MVP VT Bronze 3 HDHP
- SG - MVP VT Bronze 4
- SG - MVP VT Gold 1
- SG - MVP VT Platinum 1
- SG - MVP VT Plus Bronze 1
- SG - MVP VT Plus Bronze 5
- SG - MVP VT Plus Gold 2
- SG - MVP VT Plus Gold 3 HDHP
- SG - MVP VT Plus Reflective Silver 1
- SG - MVP VT Plus Reflective Silver 2 HDHP
- SG - MVP VT Plus Silver 1
- SG - MVP VT Plus Silver 2 HDHP
- SG - MVP VT Reflective Silver 3
- SG - MVP VT Reflective Silver 4 HDHP
- SG - MVP VT Silver 3
- SG - MVP VT Silver 4 HDHP
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 accommodations of persons with special needs at meetings, call 1-800-324-3899 (TTY 711).
Other physicians/providers are available in the MVP Health Care network. MVP virtual care services through Gia are available at no cost-share for most members. 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.
Y0051_8263_M | Last Updated: 4/13/2023
Other physicians/providers are available in the MVP Health Care network. MVP virtual care services through Gia are available at no cost-share for most members. 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.
Y0051_8263_M | Last Updated: 4/13/2023