Gold 1 NS by MVP
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- Gold 1 NS
- Insurance Company
- MVP
In Network Benefits
- Office Co-pay
- $15.00
- Specialist Co-pay
- $50.00 after deductible
- Hospital Co-pay
- $500.00 after deductible
- Emergency Room
- $350.00
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $10/$40/$60 after deductible
- In-Network Deductible (single/family)
- $1,200/$2,400
- In-Network Co-Insurance
- $0.00
- Max Out of Pocket (single/family)
- $5,900/$11,800
Out Of Network Benefits
- Co-Insurance
- N/A
- Deductible
- N/A
- Out of Pocket Max (single/family)
- N/A
Other Benefits
- Vision/Dental
- Pediatric Vision Only
- Renewal Date
- 12-31-2020
- HSA Eligible
- No
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