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 – NY
  • UVM Health Advantage
  • Individual & Family – NY & VT
  • 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 


Rochester and Buffalo



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 



Rochester and Buffalo 



Dual Special Needs Program (D-SNP) 




Summary of Benefits (SOB) 

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 


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 


Medicare Star Rating 

All Regions

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 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