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What is covered by my MVP plan?

The MVP Advantage plan offers comprehensive major medical coverage, including preventive care, primary and specialist visits, hospitalizat...

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Written by Regina Rovira

The MVP Advantage plan offers comprehensive major medical coverage, including preventive care, primary and specialist visits, hospitalization, emergency services, and more. This plan satisfies both ACA “Minimum Essential Coverage” (MEC) and “Minimum Value” (MV) requirements.

Deductible and Out-of-Pocket Maximum:

  • Annual Deductible
    $1,500 individual / $3,000 family

  • Out-of-Network Coverage
    40% coinsurance after deductible on eligible services

  • Out-of-Pocket Maximum
    $9,100 individual / $18,200 family

Key Covered Services: You can find more details on the covered services below, including what you’ll typically pay for common visits like primary care, specialist appointments, lab work, and hospital stays. We’ve also included information on maternity care, emergency services, and more—so you know exactly what’s included in your plan and what costs to expect.

  • Primary Care Visits
    $15 copay for in-network visits
    Includes preventive care, wellness checks, and chronic condition management

  • Specialist Visits
    $50 copay for in-network visits

  • Urgent Care
    $50 copay per visit

  • Emergency Room Services
    $500 copay per visit (limit 1 per year)

  • Inpatient Hospitalization
    $1,500 copay per admission (after deductible, limit 2 per year)

  • Outpatient Surgery
    $500 copay per surgery (after deductible, limit 2 per year)

  • Maternity Services
    Includes prenatal visits, delivery, and inpatient maternity care
    $350 copay for professional services, $1,500 per admission for inpatient stay

  • Prescription Drugs
    $10 copay for Tier 1 and Tier 2 drugs
    1,000+ generic prescriptions available for free through Vitable Primary Care

  • Mental Health Services
    Virtual mental health coaching included through Vitable

  • Labs and X-rays
    $50 copay for basic imaging and lab services
    $350 copay for complex imaging (e.g., CT scans, MRIs)

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