Standard Small Business Platinum Plans

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

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MVP VT Platinum 1 FRVT-HMO-SP-001-S (2023)

State Vermont
Plan Type HMO
Exchange On
Metal Level Platinum
Annual In-Network Deductible (Single/Family) $425 / $850
Annual Out-of-Network Deductible N/A
Annual In-Network Out-of-Pocket Limit (Single/Family) $1,500 / $3,000
Annual Out-of-Network Out-of-Pocket Limit N/A
Primary Care Visit $15 copay (First 3 PCP or MH, SA Visits Covered in Full)
Specialist Visit $40 copay
ER $100 copay Deductible applies.
Urgent Care $50 copay Deductible waived.
Generic Rx Coverage (Tier 1) $10 copay Deductible waived.
Preferred Rx Coverage (Tier 2) $50 copay Deductible waived. Prior authorization is required for some prescriptions
Non Preferred Rx Coverage (Tier 3) 50% coinsurance Deductible waived. Prior authorization is required for some prescriptions. Includes Diabetic Supplies and Equipment
Rx Formulary 2023 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, 2023