Benefits & Coverage
Plan Name
MVP Premier Plus Bronze 2 NS INN Dep29 Acupuncture Telemedicine
Plan ID
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Expanded Bronze
Plan Type
Deductible
Out-of-Pocket Maximum
Plan Highlights
Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness
40.00% Coinsurance after deductible
Specialist Visit
40.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services
40.00% Coinsurance after deductible
X-rays and Diagnostic Imaging
40.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans
40.00% Coinsurance after deductible
Deductible - Family
$10200 per group
Out-of-Pocket Maximum - Family
$14300 per group
Prescription drug coverage
Generic Drugs
$5 Copay after deductible
Preferred Brand Drugs
$60 Copay after deductible
Non-Preferred Brand Drugs
$80 Copay after deductible
Specialty Drugs
Not Applicable
Access to doctors and hospitals
Provider directory URL
https://www.mvphealthcare.com/members/find-a-doctor/
Does this plan have access to a national provider network?
No
Is a referral required to see a Specialist?
Not Covered
Does this plan cover services outside plan service area?
Yes - Emergency Only
Does this plan cover services outside the country?
Yes - Emergency Only
Hospital services
Emergency Room Services
40.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
40.00% Coinsurance after deductible
Inpatient Physician and Surgical Services
40.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service
40.00% Coinsurance after deductible
Maternity
Prenatal and Postnatal Care
Not Applicable
Delivery and all inpatient services for maternity care
40.00% Coinsurance after deductible
Mental Health
Mental/Behavioral Health Outpatient Services
40.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services
40.00% Coinsurance after deductible
Substance use disorder outpatient services
40.00% Coinsurance after deductible
Substance use disorder inpatient services
40.00% Coinsurance after deductible
Medical Management Programs
Does this plan offer disease managment programs?
Asthma, Depression, Diabetes, Heart Disease, Low Back Pain, Pregnancy
Does this plan offer a wellness program?
Not Covered
Vision Coverage
Routine Eye Exam for Children
Included
Eye Glasses for Children
Included
Routine Eye Exam for Adults
Not Covered
Child Dental Coverage
Child Dental Coverage - Routine Dental Care
Not Covered
Child Dental Coverage - Basic Dental Care
Not Covered
Child Dental Coverage - Orthodontia
Not Covered
Child Dental Coverage - Major Dental Care
Not Covered
Adult Dental Coverage
Adult Dental Coverage - Routine Dental Care
Not Covered
Adult Dental Coverage - Basic Dental Care
Not Covered
Adult Dental Coverage - Orthodontia
Not Covered
Adult Dental Coverage - Major Dental Care
Not Covered
Exclusions and Limitations
More Included Benefits
Other Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Bariatric Surgery
Infertility Treatment
Imaging (CT/PET Scans, MRIs)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Durable Medical Equipment
Chiropractic Care
Applied Behavior Analysis Based Therapies
Cochlear Implants
Second Opinion
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Breast Reconstructive Surgery
Cardiac Rehabilitation
Prostate Cancer Screening
Assistive Communication Devices
Autologous Blood Banking
Gym Membership Reimbursement
Medical Supplies
Preadmission Testing
Design
Diabetic Equipment and Supplies
Family Planning Services
Sterilization Procedures for Men
Telemedicine
Preventive Care/Screening/Immunization
Bariatric Surgery
Infertility Treatment
Imaging (CT/PET Scans, MRIs)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Urgent Care Centers or Facilities
Inpatient Physician and Surgical Services
Durable Medical Equipment
Chiropractic Care
Applied Behavior Analysis Based Therapies
Cochlear Implants
Second Opinion
Accidental Dental
Allergy Testing
Chemotherapy
Diabetes Education
Dialysis
Infusion Therapy
Laboratory Outpatient and Professional Services
Prosthetic Devices
Radiation
Reconstructive Surgery
Transplant
Treatment for Temporomandibular Joint Disorders
Well Baby Visits and Care
Breast Reconstructive Surgery
Cardiac Rehabilitation
Prostate Cancer Screening
Assistive Communication Devices
Autologous Blood Banking
Gym Membership Reimbursement
Medical Supplies
Preadmission Testing
Design
Diabetic Equipment and Supplies
Family Planning Services
Sterilization Procedures for Men
Telemedicine
More Limited Benefits
Skilled Nursing Facility
Acupuncture
Hearing Aids
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Hospice Services
Inpatient Rehabilitation Services
Abortion for Which Public Funding is Prohibited
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Contact Lenses for Children
Acupuncture
Hearing Aids
Home Health Care Services
Outpatient Rehabilitation Services
Habilitation Services
Hospice Services
Inpatient Rehabilitation Services
Abortion for Which Public Funding is Prohibited
Rehabilitative Occupational and Rehabilitative Physical Therapy
Rehabilitative Speech Therapy
Contact Lenses for Children
More Excluded Benefits
Cosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Dental Check-Up for Children
Routine Foot Care
Nutritional Counseling
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Dental Check-Up for Children
Routine Foot Care
Nutritional Counseling
What To Know
- This is an ACA (Obamacare) compliant health plan.
- This plan is eligible for a tax credit subsidy
Physician Directory
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