PPO Gold by MVP
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- PPO Gold
- Insurance Company
- MVP
In Network Benefits
- Office Co-pay
- $40
- Specialist Co-pay
- $60
- Hospital Co-pay
- $500 after deductible
- Emergency Room
- $300 after deductible
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $10/$40/$60
- In-Network Deductible (single/family)
- $700/$1,400
- In-Network Co-Insurance
- 0%
- Max Out of Pocket (single/family)
- $7,150/$14,300
Out Of Network Benefits
- Co-Insurance
- 20% after deductible
- Deductible
- $4,000/$8,000
- Out of Pocket Max (single/family)
- $8,000/$16,000
Other Benefits
- Vision/Dental
- Pediatric Vision and Dental; Adult Vision Only
- Renewal Date
- Annual
- HSA Eligible
- No
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