MVP Silver HSA VT

Plan Information
Company MVP Health Plan
State VT
Metal Tier Silver
Plan Type HDH

Cost Sharing Benefits

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.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $1,550 Data Not Available
Deductible (Family) $3,100 Data Not Available
Coinsurance 20% Data Not Available
Out of Pocket Maximum (Individual) $5,750 Data Not Available
Out of Pocket Maximum (Family) $11,500 Data Not Available
Services In Network Out of Network
Primary Care Visit 10% coinsurance Data Not Available
Specialist Visit 20% coinsurance Data Not Available
In Patient Hospital Services 20% coinsurance Data Not Available
Emergency Room Services 20% coinsurance 20% coinsurance
Mental / Behavioral Health Data Not Available Data Not Available
Imaging (CT/PET Scans, MRIs) Data Not Available Data Not Available
Rehabilitative Speech Therapy Data Not Available Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available Data Not Available
Preventative Care $0 Data Not Available
Laboratory Outpatient and Professional Services Data Not Available Data Not Available
X-ray and Diagnostic Imaging Data Not Available Data Not Available
Prescription Drugs In Network Out of Network
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.

Plan Name
Platinum
Gold
Silver Deductible
Silver HSA
Bronze Deductible
Bronze HSA
Catastrophic
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