Standard Individual Platinum Plans

MVP Health Care standard individual platinum plans, part of MVP's suite of Premier plans offered on New York State of Health.

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MVP Premier PlatinumFRNY-HMO-DP-001-S (2017)

State: New York
Plan Type: HMO
Exchange: On
Metal Level: Platinum
Annual In-Network Deductible (Single/Family): $0 / $0
Annual Out-of-Network Deductible (Single/Family): $0 / $0
Annual In-Network Out-of-Pocket Limit (Single/Family): $2,000 / $4,000
Annual Out-of-Network Out-of-Pocket Limit: N/A
Primary Care Visit: $15 copay
Specialist Visit: $35 copay
ER: $100 copay waived if admitted to hospital
No Deductible.
Urgent Care: $55 copay
No Deductible.
Generic Rx Coverage (Tier 1): $10 copay
No Deductible.30 day supply retail
Preferred Rx Coverage (Tier 2): $30 copay
No Deductible.30 day supply retail
Non Preferred Rx Coverage (Tier 3): $60 copay
No Deductible.30 day supply retail
Rx Formulary: Click here to open the 2016 Rx Formulary (PDF)
Rx/Drug Search: Pharmacy Information for New York’s Prescription Drug Program
Find a Doctor: Doctor Search
Summary of Benefits and Coverage (SBC): Click here to open detailed plan benefit information (PDF)
Plan Overview: Click here to open the plan overview document (PDF)
Plan Highlights: Telemedicine and $125 in wellness benefits
Wellness Features: MVP Wellness Program
Availability: January 1, 2017

MVP Premier PlatinumFRNY-HMO-DPA1-001-S (2017)

State: New York
Plan Type: HMO
Exchange: On
Metal Level: Platinum
Annual In-Network Deductible (Single/Family): $0 / $0
Annual Out-of-Network Deductible (Single/Family): $0 / $0
Annual In-Network Out-of-Pocket Limit: N/A
Annual Out-of-Network Out-of-Pocket Limit: N/A
Primary Care Visit: $0 copay
Specialist Visit: $0 copay
ER: $0 copay waived if admitted to hospital
No Deductible.
Urgent Care: $0 copay
No Deductible.
Generic Rx Coverage (Tier 1): $0 copay
No Deductible.30 day supply retail
Preferred Rx Coverage (Tier 2): $0 copay
No Deductible.30 day supply retail
Non Preferred Rx Coverage (Tier 3): $0 copay
No Deductible.30 day supply retail
Rx Formulary: Click here to open the 2016 Rx Formulary (PDF)
Rx/Drug Search: Pharmacy Information for New York’s Prescription Drug Program
Special Eligibility:American Indian/Alaska Native
Find a Doctor: Doctor Search
Summary of Benefits and Coverage (SBC): Click here to open detailed plan benefit information (PDF)
Plan Overview: Click here to open the plan overview document (PDF)
Plan Highlights: Telemedicine and $125 in wellness benefits
Wellness Features: MVP Wellness Program
Availability: January 1, 2017

Special Eligibility Only