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 (2021)

State Vermont
Plan Type HMO
Exchange On
Metal Level NA
Annual In-Network Deductible (Single/Family) $8,550 / $17,100
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 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) 0% coinsurance Deductible applies. 30 day retail/90 day mail order.
Preferred Rx Coverage (Tier 2) 0% coinsurance Deductible applies. Prior authorization is required for some prescriptions. 30 day retail/90 day mail order
Non Preferred Rx Coverage (Tier 3) 0% coinsurance Deductible applies. Prior authorization is required for some prescriptions. 30 day retail/90 day mail order. Includes Diabetic Supplies and Equipment.
Rx Formulary 2021 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 $0 telemedicine services, Cigna national network, pediatric dental, 20% discount on CVS brand health-related items
Well-Being Features Online Tools & Activities
Availability January 1, 2021