Non Standard Small Business Silver Plans

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

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MVP VT Plus Reflective Silver 1 VT-HMO-SS-001-N II (2022)

State Vermont
Plan Type HMO
Exchange Off
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) $6,950 / $13,900
Annual Out-of-Network Out-of-Pocket Limit N/A
Primary Care Visit $30 copay (First 3 visits no Deductible)
Specialist Visit $60 copay
ER $400 copay Deductible applies.
Urgent Care $60 copay Deductible applies.
Generic Rx Coverage (Tier 1) $5 copay Deductible applies. VBID 30 day supply $1/90 day supply $2.50.
Preferred Rx Coverage (Tier 2) 50% coinsurance Deductible applies. VBID 30 day supply $1/90 day supply $2.50. Prior authorization required for some prescriptions
Non Preferred Rx Coverage (Tier 3) 50% coinsurance Deductible applies. VBID 30 day supply $1/90 day supply $2.50. Prior authorization 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 Reflective Silver 2 HDHP VT-HMOH-SS-002-N II (2022)

State Vermont
Plan Type HMO
Exchange Off
Metal Level Silver
Annual In-Network Deductible (Single/Family) $5,100 / $10,200
Annual Out-of-Network Deductible N/A
Annual In-Network Out-of-Pocket Limit (Single/Family) $5,100 / $10,200
Annual Out-of-Network Out-of-Pocket Limit N/A
Primary Care Visit 0% coinsurance
Specialist Visit 0% coinsurance
ER 0% coinsurance Deductible applies.
Urgent Care 0% coinsurance Deductible applies.
Generic Rx Coverage (Tier 1) 0% coinsurance Deductible applies. 30 day supply/90 day supply; preventive drugs deductible waived.
Preferred Rx Coverage (Tier 2) 0% coinsurance Deductible applies. 30 day supply/90 day supply; preventive drugs deductible waived. Prior authorization is required for some prescriptions
Non Preferred Rx Coverage (Tier 3) 0% coinsurance Deductible applies. 30 day supply/90 day supply; preventive drugs deductible waived. 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 Silver 1 FRVT-HMO-SS-001-N (2022)

State Vermont
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) $6,950 / $13,900
Annual Out-of-Network Out-of-Pocket Limit N/A
Primary Care Visit $30 copay (First 3 visits no Deductible)
Specialist Visit $60 copay
ER $400 copay Deductible applies.
Urgent Care $60 copay Deductible applies.
Generic Rx Coverage (Tier 1) $5 copay Deductible applies. VBID 30 day supply $1/90 day supply $2.50.
Preferred Rx Coverage (Tier 2) 50% coinsurance Deductible applies. VBID 30 day supply $1/90 day supply $2.50. Prior authorization required for some prescriptions
Non Preferred Rx Coverage (Tier 3) 50% coinsurance Deductible applies. VBID 30 day supply $1/90 day supply $2.50. Prior authorization 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 Silver 2 HDHP FRVT-HMOH-SS-002-N (2022)

State Vermont
Plan Type HMO
Exchange On
Metal Level Silver
Annual In-Network Deductible (Single/Family) $5,075 / $10,150
Annual Out-of-Network Deductible N/A
Annual In-Network Out-of-Pocket Limit (Single/Family) $5,075 / $10,150
Annual Out-of-Network Out-of-Pocket Limit N/A
Primary Care Visit 0% coinsurance
Specialist Visit 0% coinsurance
ER 0% coinsurance Deductible applies.
Urgent Care 0% coinsurance Deductible applies.
Generic Rx Coverage (Tier 1) 0% coinsurance Deductible applies. 30 day supply/90 day supply; preventive drugs deductible waived.
Preferred Rx Coverage (Tier 2) 0% coinsurance Deductible applies. 30 day supply/90 day supply. Preventive drugs deductible waived. Prior authorization is required for some prescriptions
Non Preferred Rx Coverage (Tier 3) 0% coinsurance Deductible applies. 30 day supply/90 day supply; preventive drugs deductible waived. 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