Premier Gold 2 ST by MVP
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- Premier Gold 2 ST
- Insurance Company
- MVP
In Network Benefits
- Office Co-pay
- $25 ($25 first 3 visits) after deductible
- Specialist Co-pay
- $40 after deductible
- Hospital Co-pay
- $1,000 after deductible
- Emergency Room
- $150 after deductible
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $10/$40/$80
- In-Network Deductible (single/family)
- $650/$1,300
- In-Network Co-Insurance
- 0%
- Max Out of Pocket (single/family)
- $5,000/ $10,000
Out Of Network Benefits
- Deductible (single/family)
- N/A
- Co-Insurance
- N/A
- Out of Pocket Max (single/family)
- N/A
Other Benefits
- Vision/Dental
- Pediatric Vision Only
- HSA Eligible
- No
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