MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP - 56184NY0210012 Health Insurance Plan
MVP Health Plan, Inc. health insurance plan with the Plan ID 56184NY0210012. The plan is called MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP .
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 79.17% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 20.83% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.
| Health Insurance Plan ID | 56184NY0210012 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2023 | ||||||||||||||||||
| State | New York | ||||||||||||||||||
| Health Insurance Issuer | MVP Health Plan, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 56184NY0210012-01 | ||||||||||||||||||
| Provider Network(s) | ['NYN002'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 07 May 2024 06:08 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Mon, 23 Jan 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 07 May 2024 06:08 GMT |
MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan Variant 56184NY0210012-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.791655185 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult-Only |
| Composite Rating Offered | No |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, Pregnancy, Low Back Pain |
| First Tier Utilization | 100% |
| Formulary ID | NYF006 |
| HIOS Product ID | 56184NY021 |
| HSA/HRA Employer Contribution | No |
| Import Date | 1/23/2023 |
| HSA Eligible | Yes |
| IsItANewPlan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 56184 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | NYN002 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Emergency Only |
| Plan Effective Date | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 56184NY0210012-01 |
| Plan Marketing Name | MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP |
| Plan Type | HMO |
| Plan Variant Marketing Name | MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $300 |
| SBC Scenario, Having a Baby, Deductible | $1,600 |
| SBC Scenario, Having a Baby, Limit | $70 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $300 |
| SBC Scenario, Having Diabetes, Deductible | $1,600 |
| SBC Scenario, Having Diabetes, Limit | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,600 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $10 |
| Service Area ID | NYS002 |
| Source Name | SERFF |
| Plan ID | 56184NY0210012 |
| State Code | NY |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family | $1600 per person | $3200 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $1,600 |
| TEHBDedOutofNetFamily | per person not applicable | per group not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $5000 per person | $10000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $5,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family | per person not applicable | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | No |
| Version Number | 1 |
| Wellness Program Offered | No |
Copay & Coinsurance of MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan, 56184NY0210012
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP , 56184NY0210012 Health Insurance Plan, 56184NY0210012
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Does MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan, 56184NY0210012 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (56184NY0210012) Health Insurance Plan, Variant (56184NY0210012-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy, Low Back Pain
Does (56184NY0210012) Health Insurance Plan, Variant (56184NY0210012-01) have Out Of Country Coverage?
Yes. Details: Emergency Only
Does (56184NY0210012) Health Insurance Plan, Variant (56184NY0210012-01) have Out of Service Area Coverage?
Yes. Details: Emergency Only
Does (56184NY0210012) Health Insurance Plan, Variant (56184NY0210012-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, Pregnancy, Low Back Pain
Does MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan, Variant (56184NY0210012-01) offer Disease Management Programs for Asthma?
Yes, the MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan Variant
56184NY0210012-01 offers Disease
Management Program for Asthma.
Does MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan, Variant (56184NY0210012-01) offer Disease Management Programs for Heart disease?
Yes, the MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan Variant
56184NY0210012-01 offers Disease
Management Program for Heart disease.
Does MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan, Variant (56184NY0210012-01) offer Disease Management Programs for Depression?
Yes, the MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan Variant
56184NY0210012-01 offers Disease
Management Program for Depression.
Does MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan, Variant (56184NY0210012-01) offer Disease Management Programs for Diabetes?
Yes, the MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan Variant
56184NY0210012-01 offers Disease
Management Program for Diabetes.
Does MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan, Variant (56184NY0210012-01) offer Disease Management Programs for Low back pain?
Yes, the MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan Variant
56184NY0210012-01 offers Disease
Management Program for Low back pain.
Does MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan, Variant (56184NY0210012-01) offer Disease Management Programs for Pregnancy?
Yes, the MVP HMO Gold 2 HDHP, Gold, INN, NY Small Group HMO, Dep29, Acupuncture, HSA, Preferred Facility, Preventive Drug, Telemedicine, Wellness, Pediatric Dental, DP Health Insurance Plan Variant
56184NY0210012-01 offers Disease
Management Program for Pregnancy.
Disclaimer: This is based on the import(Date: Tue, 07 May 2024 06:08 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API