Non Standard Small Business Bronze Plans

MVP VT Plus (non-standard) plans for Vermont small businesses offered on Vermont Health Connect.

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MVP VT Plus Bronze 1 FRVT-HMO-SB-001-N (2022)

State Vermont
Plan Type HMO
Exchange On
Metal Level Bronze
Annual In-Network Deductible (Single/Family) $7,250 / $14,500
Annual Out-of-Network Deductible N/A
Annual In-Network Out-of-Pocket Limit (Single/Family) $8,400 / $16,800
Annual Out-of-Network Out-of-Pocket Limit N/A
Primary Care Visit $40 copay
Specialist Visit $100 copay
ER 50% coinsurance Deductible applies.
Urgent Care $100 copay Deductible applies.
Generic Rx Coverage (Tier 1) $25 copay Deductible waived. VBID 30 day supply $3/90 day supply $7.50.
Preferred Rx Coverage (Tier 2) $100 copay Deductible applies. VBID 30 day supply $3/90 day supply $7.50. Prior authorization is required for some prescriptions
Non Preferred Rx Coverage (Tier 3) 60% coinsurance Deductible applies. VBID 30 day supply $3/90 day supply $7.50. Prior authorization is required for some prescriptions. Includes Diabetic Supplies and Equipment
Rx Formulary 2022 MVP Marketplace Formulary (PDF)
Rx Drug Search Pharmacy Information for Vermont’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 $500 acupuncture allowance, Cigna national network, pediatric dental, 20% discount on CVS brand health-related items
Well-Being Features $600 WellBeing Rewards
Availability January 1, 2022

MVP VT Plus Bronze 5 FRVT-HMO-SB-005-N (2022)

State Vermont
Plan Type HMO
Exchange On
Metal Level Bronze
Annual In-Network Deductible (Single/Family) $7,850 / $15,700
Annual Out-of-Network Deductible N/A
Annual In-Network Out-of-Pocket Limit (Single/Family) $7,850 / $15,700
Annual Out-of-Network Out-of-Pocket Limit N/A
Primary Care Visit 0% coinsurance (First 3 visits no Deductible)
Specialist Visit 0% coinsurance
ER 0% coinsurance Deductible applies.
Urgent Care 0% coinsurance Deductible applies.
Generic Rx Coverage (Tier 1) $35 copay Deductible waived. VBID 30 day supply $3/90 day supply $7.50.
Preferred Rx Coverage (Tier 2) 0% coinsurance Deductible applies. VBID 30 day supply $3/90 day supply $7.50. Prior authorization is required for some prescriptions
Non Preferred Rx Coverage (Tier 3) 0% coinsurance Deductible applies. VBID 30 day supply $3/90 day supply $7.50. Prior authorization is required for some prescriptions. Includes Diabetic Supplies and Equipment
Rx Formulary 2022 MVP Marketplace Formulary (PDF)
Rx Drug Search Pharmacy Information for Vermont’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 $500 acupuncture allowance, Cigna national network, pediatric dental, 20% discount on CVS brand health-related items
Well-Being Features $600 WellBeing Rewards
Availability January 1, 2022