Standard Individual Catastrophic Plans

MVP VT (standard) plans for Vermont individuals offered on Vermont Health Connect.

View all MVP VT Individual & Family Plans

MVP VT Secure FRVT-HMOC-001-N (2022)

State Vermont
Plan Type HMO
Exchange On
Metal Level NA
Annual In-Network Deductible (Single/Family) $8,700 / $17,400
Annual Out-of-Network Deductible N/A
Annual In-Network Out-of-Pocket Limit (Single/Family) $8,700 / $17,400
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
Preferred Rx Coverage (Tier 2) 0% coinsurance Deductible applies. 30 day supply/90 day supply; Prior authorization is required for some prescriptions
Non Preferred Rx Coverage (Tier 3) 0% coinsurance Deductible applies. 30 day supply/90 day supply; 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 Cigna national network, pediatric dental, 20% discount on CVS brand health-related items
Well-Being Features Not covered
Availability January 1, 2022