MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP - 56184NY0170160 Health Insurance Plan
MVP Health Plan, Inc. health insurance plan with the Plan ID 56184NY0170160. The plan is called MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 80.06% (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 19.94% 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 | 56184NY0170160 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| State | New York | ||||||||||||||||||
| Health Insurance Issuer | MVP Health Plan, Inc. | ||||||||||||||||||
| Health Insurance Plan Variant | 56184NY0170160-01 | ||||||||||||||||||
| Provider Network(s) | ['NYN002'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 21 Jan 2025 05:40 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Mon, 12 Feb 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 21 Jan 2025 05:40 GMT |
MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan Variant 56184NY0170160-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.800556906 |
| Business Year | 2024 |
| Child-Only Offering | Allows Adult-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Drug EHB Deductible, In Network (Tier 1), Family | $0 per person | $0 per group |
| Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| Drug EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Disease Management Programs Offered | Pregnancy, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma |
| First Tier Utilization | 100% |
| Formulary ID | NYF012 |
| HIOS Product ID | 56184NY017 |
| HSA/HRA Employer Contribution | No |
| Import Date | 2/12/2024 |
| HSA Eligible | No |
| IsItANewPlan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 56184 |
| Market Coverage | SHOP (Small Group) |
| Medical Drug Deductibles Integrated | No |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Medical EHB Deductible, Combined In/Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Medical EHB Deductible, In Network (Tier 1), Family | $0 per person | $0 per group |
| Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
| Medical EHB Deductible, Out of Network, Family | per person not applicable | per group not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| 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 | 1/1/2024 |
| Plan Expiration Date | 12/31/2024 |
| Plan ID (Standard Component ID with Variant) | 56184NY0170160-01 |
| Plan Marketing Name | MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP |
| Plan Type | HMO |
| Plan Variant Marketing Name | MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $5,600 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $300 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $1,400 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | NYS002 |
| Source Name | SERFF |
| Plan ID | 56184NY0170160 |
| 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 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family | $7000 per person | $14000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,000 |
| 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 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan, 56184NY0170160
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP, 56184NY0170160 Health Insurance Plan, 56184NY0170160
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Does MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan, 56184NY0170160 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (56184NY0170160) Health Insurance Plan, Variant (56184NY0170160-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Pregnancy, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
Does (56184NY0170160) Health Insurance Plan, Variant (56184NY0170160-01) have Out Of Country Coverage?
Yes. Details: Emergency Only
Does (56184NY0170160) Health Insurance Plan, Variant (56184NY0170160-01) have Out of Service Area Coverage?
Yes. Details: Emergency Only
Does (56184NY0170160) Health Insurance Plan, Variant (56184NY0170160-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Pregnancy, Depression, Low Back Pain, Diabetes, Heart Disease, Asthma
Does MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan, Variant (56184NY0170160-01) offer Disease Management Programs for Asthma?
Yes, the MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan Variant
56184NY0170160-01 offers Disease
Management Program for Asthma.
Does MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan, Variant (56184NY0170160-01) offer Disease Management Programs for Heart disease?
Yes, the MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan Variant
56184NY0170160-01 offers Disease
Management Program for Heart disease.
Does MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan, Variant (56184NY0170160-01) offer Disease Management Programs for Depression?
Yes, the MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan Variant
56184NY0170160-01 offers Disease
Management Program for Depression.
Does MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan, Variant (56184NY0170160-01) offer Disease Management Programs for Diabetes?
Yes, the MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan Variant
56184NY0170160-01 offers Disease
Management Program for Diabetes.
Does MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan, Variant (56184NY0170160-01) offer Disease Management Programs for Low back pain?
Yes, the MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan Variant
56184NY0170160-01 offers Disease
Management Program for Low back pain.
Does MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan, Variant (56184NY0170160-01) offer Disease Management Programs for Pregnancy?
Yes, the MVP HMO Gold 12, Gold, INN, NY Small Group HMO, Dep25, Acupuncture, Preferred Facilities, Telemedicine, Unlimited SNF, Wellness, DP Health Insurance Plan Variant
56184NY0170160-01 offers Disease
Management Program for Pregnancy.
Disclaimer: This is based on the import(Date: Tue, 21 Jan 2025 05:40 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