2018 MVP Premier Plus HDHP Silver 3 NS INN Dep29 Acupuncture Preven Plan Details - HealthPocket

MVP Premier Plus HDHP Silver 3 NS INN Dep29 Acupuncture Preven

$638.33/mo

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Zip Code11226
Applicant10/22/1983 Male
Coverage Start10/23/2018
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameMVP Premier Plus HDHP Silver 3 NS INN Dep29 Acupuncture Preven
Plan IDhhs-56184NY0200005
Plan Year2018
Insurance ProviderMVP
Metal LevelSilver
Plan TypeHMO
Deductible$2,500
Out-of-Pocket Maximum$5,000
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness$30 Copay after deductible
Specialist Visit$60 Copay after deductible
Laboratory Outpatient and Professional Services$60 Copay after deductible
X-rays and Diagnostic Imaging$60 Copay after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans$150 Copay after deductible
Deductible - Family$5000 per group
Out-of-Pocket Maximum - Family$10000 per group

Prescription drug coverage

Generic Drugs$10 Copay after deductible
Preferred Brand Drugs$45 Copay after deductible
Non-Preferred Brand Drugs$90 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$300 Copay after deductible
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$300 Copay after deductible

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$30 Copay after deductible
Mental/Behavioral Health Inpatient Services$500 Copay per Day after deductible
Substance use disorder outpatient services$30 Copay after deductible
Substance use disorder inpatient services$500 Copay per Day 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
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 BenefitsSkilled 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
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
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MVP Premier Silver 2 Child Only ST3PCP INN SNF Telemedicine Wel
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Healthfirst Silver Leaf Premier, NS, INN, Dep25, Family Dental,
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Healthfirst Silver Leaf Premier, NS, INN, Dep29, Family Dental,
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  • What Is the Silver Plan?

    ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.

  • How are Silver 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 Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.

  • How much does a Silver Plan cost?

    The monthly premium for a Silver 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 the region in which you live. You can use HealthPocket’s comparison tool to compare Silver Plan premiums in your area.

  • When Can I Enroll in a Silver 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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