MVP Silver HSA (Vermont)

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Company MVP Health Plan
Plan Year 2014
State Vermont
Metal Tier Silver
Plan Type HDH
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Cost Sharing Benefits (In Network)

These details are for the standard Silver plan. For reduced Cost Sharing versions scroll down below

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $1,550
Deductible (Family) $3,100
Coinsurance 20%
Out of Pocket Maximum (Individual) $5,750
Out of Pocket Maximum (Family) $11,500

Doctors Visits

Primary Care Visit 10% coinsurance
Specialist Visit 20% coinsurance
In Patient Hospital Services 20% coinsurance
Emergency Room Services 20% coinsurance

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
Laboratory Outpatient and Professional Services Data Not Available
X-ray and Diagnostic Imaging Data Not Available


Mental / Behavioral Health Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility Data Not Available
Outpatient Surgery 20% coinsurance

Prescription Drugs

Generic Rx $10 copay
Preferred Brand Rx $40 copay
Non Preferred Brand Rx 50% coinsurance
Specialty Drugs 0.5

Other Plans

Other plans that are available in the state.

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Comments And Questions

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