NEW YORK PREMIER PLANS At A GLANCe SMALL

NEW YORK PREMIER PLANS At A GLANCe
SMALL GROUP ON-EXCHANGE with premiums for the Albany Region
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Coverage to meet your needs and help you take on life and live well!
$1,000 for out-of-area coverage.^
Affordable pharmacy.
Convenient online resources.
PreMIer PLus PLANs
PLAN FEATURE
PLATINUM 1
PLATINUM 2
GOLD 1
MVP Premier Plus Plans (Non-Standard)
MVP Premier Plans (Standard)
METAL LEVEL
METAL LEVEL
GOLD 2 HDHP
SILVER 1
SILVER 2
AGGREGATE
SILVER 3 HDHP BRONZE 1
BRONZE 2
AGGREGATE
BRONZE 3 HDHP
PLATINUM
GOLD
SILVER
BRONZE
EMBEDDED
$0
$0
$850
$1,400
$1,900
$1,500
$1,500
$3,500
$4,000
$4,000
$0
$600
$2,000
$3,000
$3,000
$2,500
$6,350
$6,350
$6,350
$6,350
$6,350
$6,350
$6,350
$6,350
$2,000
$4,000
$5,500
$6,350
Preventive Care
Primary Care
$0
3 visits at $0
and then $5
$0
$5
$0
$30 (not
subject to
deductible)
$0
$25*
$0
$30*
$0
50%*
$30
$50*
$80*
$0
$0
3 visits at $0
$30*
and then $35
(not subject
to deductible)
$60*
$50*
$0
$15
$40
$0
$0
3 visits at $0
$25*
and then $35
(not subject
to deductible)
$60*
$50*
$0
$35*
Specialist Visit
Hospital Facility
Visit: Inpatient
Outpatient
Urgent Care
$0
$0
3 visits at $0
$5*
and then $15
(not subject
to deductible)
$45*
$15*
$35
$40*
$50*
50%*
$300
$100
$40
$300
$100
$30
$500*
$200*
$45*
$200*
$100*
$15*
20%*
$300*
$50*
$100
$100
$300 (not
subject to
deductible)
$75*
$350*
$0
$0
$5/$30/$50
$0 generic
until age 10
$5/$30/$50
$0 generic
until age 10
$100 (Name
brand only)
$5/$35/$70*
$0 generic
until age 10†
Integrated
w/Medical
$5/$15/$25*
(preventive
drugs not
subject to
deductible)
$100 (Name
brand only)
$8/$35/$70*
$0 generic
until age 10†
Plan Deductible–
Individual
Out-of-Pocket
Maximum
MEDICAL
Emergency
Room Visit
20%*
$200*
$60 (not
subject to
deductible)
$350 (not
subject to
deductible)
$500*
$200*
$50*
50%*
$300*
$80*
30%*
$300*
$60*
30%*
$100*
$50*
$500
$100
$55
$1,000*
$100*
$60*
$1,500*
$100*
$70*
50%*
50%*
50%*
$300*
50%*
$350 (not
subject to
deductible)
$300*
$100
$150*
$150*
50%*
Integrated
w/Medical
$8/$35/$70*
$0 generic
until age 10*
Integrated
w/Medical
$10/$40/$60*
(preventive
drugs not
subject to
deductible)
$200
Integrated
w/Medical
$5/$40/$60*
(preventive
drugs not
subject to
deductible)
$0
$0
$0
$10/
$30/
$60
$10/
$35/
$70
$10/
$35/
$70
Integrated
w/Medical
$10/
$35/
$70*
PHARMACY
Prescription
Deductible
Prescription
Copayment
Integrated
w/Medical
$10/$40/50%* $8/$40/$60*
$0 generic
$0 generic
until age 10*
until age 10*
WELLNESS BENEFITS – MVP PREMIER PLUS PLANS
WELLNESS BENEFITS – MVP PREMIER PLANS
All New York MVP Premier Plus Plans include up to $125 per contract in reimbursement for gym and fitness club membership, youth sports and fitness fees
or healthy weight support programs. Plans also include access to MVP’s suite of online wellness tools and activities.
All New York MVP Premier Plans include up to $600 in gym
reimbursement benefits per contract and access to MVP’s suite
of online wellness tools and activities.
^Per dependent child for all Premier Plus plans. benefits are subject to the same cost sharing arrangements for each particular plan.
*Member amount after deductible is met
†Generic drugs are NOt subject to deductible
“MVP Health Care” is the parent company of MVP Health Insurance Company; MVP Health Plan, Inc.; MVP Health Insurance Company
of New Hampshire, Inc.; MVP Health Plan of New Hampshire, Inc.; MVP select Care, Inc.; Preferred Administrative services, Inc.; and
Preferred Assurance Company, Inc., which issue or administer health benefit plans. Not all plans available in all counties.
LEVELS OF COVERAGE
All health plans on the exchange will be offered in a tiered format based on
four metal levels that match the percentage of costs covered. As the metal
level goes down, the monthly premium goes down while the member's
out-of-pocket cost share goes up.
Out-Of-POCket COsts
90%
PLATINUM
80%
GOLD
70%
SILVER
60%
BRONZE
COst COVered bY YOur PreMIuM
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NY PreMIer sG ON_ALbANY (9/30/13)
see back for premiums and other information 
NEW YORK
PREMIER PLANS
PLAN FEATURE
PLATINUM 1
PLATINUM 2
GOLD 1
FIND US ON
ALBANY REGION
Counties include:
• Albany
• Columbia
• fulton
• Greene
• Montgomery
• rensselaer
$526.93
$1,053.86
$895.78
$1,501.75
$530.29
$1,060.58
$901.49
$1,511.33
$440.56
$881.12
$748.95
$1,255.60
Non-Standard Plans
Standard Plans
RATES EFFECTIVE 1/1/2014 - 3/31/2014
METAL LEVEL
GOLD 2 HDHP
$418.97
$837.94
$712.25
$1,194.06
• saratoga
• schenectady
• schoharie
• Warren
• Washington
RATES EFFECTIVE 1/1/2014 - 3/31/2014
METAL LEVEL
SILVER 1
SILVER 2
AGGREGATE
Single
Single + Spouse
Single + Child(ren)
Single + Spouse +
Child(ren)
NYStateofHealth.NY.gov
SILVER 3 HDHP BRONZE 1
BRONZE 2
AGGREGATE
$357.24
$714.48
$607.31
$1,018.13
$368.79
$737.58
$626.94
$1,051.05
$370.80
$741.60
$630.36
$1,056.78
BRONZE 3 HDHP
PLATINUM
GOLD
SILVER
BRONZE
$526.60
$1,053.20
$895.22
$1,500.81
$446.55
$893.10
$759.14
$1,272.67
$370.98
$741.96
$630.67
$1,057.29
$285.30
$570.60
$485.01
$813.11
EMBEDDED
$295.86
$591.72
$502.96
$843.20
$298.79
$597.58
$507.94
$851.55
$284.65
$569.30
$483.91
$811.25
QUALITY BENEFITS FROM A NAME YOU KNOW AND TRUST
In addition to quality coverage, MVP will continue to provide top-rated customer service, unique wellness options and innovative tools to all of our members.
WELLNESS BENEFITS
UP TO $125 per contract in REIMBURSEMENT
for gym and fitness club membership, youth sports
and fitness fees or healthy weight support programs
PERSONALIZED GUIDANCE and support through
MVP’s Health Management Programs, 24/7 Nurse
Advice Line and full suite of online wellness tools
and resources, including a Personal Health Assessment and online health improvement classes
EXCLUSIVE MEMBER DISCOUNTS on a
wide range of health and wellness services,
from fitness clubs
and vitamins to
acupuncture and
massage therapy
INTRODUCING THE
myMVP MOBILE APP
MVP knows you’re constantly
on the move, so we created
an innovative mobile app to fit
your mobile lifestyle, featuring:
• INSTANTLY ACCESS your
Id card, find a doctor nearby
and connect with MVP
• Visit the App store or
Google Play to DOWNLOAD
the myMVP app FOR FREE
on your mobile device
(MsG&dAtA rates may apply)
ONLINE RX RESOURCES
Check out all of MVP’s online rX resources at
mvphealthcare.com under Manage Prescriptions:
• find your medications on the
MVP formulary
• find a Pharmacy
• Order prescriptions through
the mail order pharmacy
• Access personalized
online pharmacy services,
including My Rx Choices®,
the express scripts prescription
drug comparison and savings
program
MAKE THE MOST OF
DiscoverMVP.com
Visit DiscoverMVP.com for a variety of resources to
help you make the best health insurance decisions:
• Get more information on MVP’s New York
plans – including the ability to find a plan
based on specific search filters
• Information on how to purchase a plan
• Ability to download and print
summary of benefits and
Coverage (sbC) for each plan
• Comprehensive Health Care
reform center with Infographics,
fAQs, Insurance terms
Glossary and blog posts
• download the myMVP app
• MVP Community blog