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 |