2018 MVP Premier Plus Gold 1 NS INN Dep29 SNF Acupuncture Telemedici Plan Details - HealthPocket

MVP Premier Plus Gold 1 NS INN Dep29 SNF Acupuncture Telemedici

$780.49/mo

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Zip Code11226
Applicant10/18/1983 Male
Coverage Start10/20/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameMVP Premier Plus Gold 1 NS INN Dep29 SNF Acupuncture Telemedici
Plan IDhhs-56184NY0150025
Plan Year2018
Insurance ProviderMVP
Metal LevelGold
Plan TypeHMO
Deductible$950
Out-of-Pocket Maximum$5,500
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$15 Copay
Specialist Visit$50 Copay after deductible
Laboratory Outpatient and Professional Services$50 Copay
X-rays and Diagnostic Imaging$60 Copay after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans$160 Copay after deductible
Deductible - Family$1900 per group
Out-of-Pocket Maximum - Family$11000 per group

Prescription drug coverage

Generic Drugs$10 Copay
Preferred Brand Drugs$40 Copay after deductible
Non-Preferred Brand Drugs$60 Copay after deductible
Specialty DrugsNot Applicable

Access to doctors and hospitals

Provider directory URLhttps://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$350 Copay
Inpatient Hospital Services (e.g., Hospital Stay)$500 Copay per Stay after deductible
Inpatient Physician and Surgical Services$100 Copay after deductible
Emergency Transportation or Ambulance Service$350 Copay

Maternity

Prenatal and Postnatal CareNot Applicable
Delivery and all inpatient services for maternity care$600 Copay after deductible

Mental Health

Mental/Behavioral Health Outpatient Services$15 Copay
Mental/Behavioral Health Inpatient Services$500 Copay per Stay after deductible
Substance use disorder outpatient services$15 Copay
Substance use disorder inpatient services$500 Copay per Stay 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 ChildrenIncluded
Eye Glasses for ChildrenIncluded
Routine Eye Exam for AdultsNot Covered

Child Dental Coverage

Child Dental Coverage - Routine Dental CareNot Covered
Child Dental Coverage - Basic Dental CareNot Covered
Child Dental Coverage - OrthodontiaNot Covered
Child Dental Coverage - Major Dental CareNot Covered

Adult Dental Coverage

Adult Dental Coverage - Routine Dental CareNot Covered
Adult Dental Coverage - Basic Dental CareNot Covered
Adult Dental Coverage - OrthodontiaNot Covered
Adult Dental Coverage - Major Dental CareNot Covered

Exclusions and Limitations

More Included BenefitsOther Practitioner Office Visit (Nurse, Physician Assistant)
Preventive Care/Screening/Immunization
Skilled Nursing Facility
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 BenefitsAcupuncture
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 BenefitsCosmetic Surgery
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Weight Loss Programs
Dental Check-Up for Children
Routine Foot Care
Nutritional Counseling
PremiumPlan NameDeductible
from $593
Gold Select NS INN Dep25
$750.00Select
from $594
Gold Select NS INN Pediatric Dental Dep25
$750.00Select
from $604
Gold Select NS INN Dep29
$750.00Select
from $605
Gold Select NS INN Pediatric Dental Dep29
$750.00Select
from $608
Choice Plus Gold NS OON Dep25 Adult Vision Wellness Nurse Helpl
$1,000.00Select
  • What is the Gold Plan?

    ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.

  • How are Gold Plans different than other Obamacare health plans?

    The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Gold Plan typically pays 80% of covered medical costs.

  • How much does a Gold Plan cost?

    The monthly premium for a Gold Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.

  • When Can I Enroll in a Gold Plan?

    The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.

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