Silver 11 NS by MVP
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- Silver 11 NS
- Insurance Company
- MVP
In Network Benefits
- Office Co-pay
- $35.00
- Specialist Co-pay
- $55.00
- Hospital Co-pay
- No Charge after deductible
- Emergency Room
- No Charge after deductible
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $10/No charge after deductible/No charge after deductible
- In-Network Deductible (single/family)
- $5,850/$11,700
- In-Network Co-Insurance
- $0.00
- Max Out of Pocket (single/family)
- $5,850/$11,700
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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