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Premier Plus Silver 3 HDHP HSA by MVP

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Plan Information

Plan Name
Premier Plus Silver 3 HDHP HSA
Insurance Company
MVP

In Network Benefits

Office Co-pay
$30 after deductible
Specialist Co-pay
$60 after deductible
Hospital Co-pay
$500 after deductible
Emergency Room
$325 after deductible
Referrals Needed
No
Rx: Generic/Brand/High Brand
$10/$35/$90 all after deductible
In-Network Deductible (single/family)
$2,650 / $5,300
In-Network Co-Insurance
N/A
Max Out of Pocket (single/family)
$6,200 / $12,400

Out Of Network Benefits

Deductible (single/family)
N/A
Co-Insurance
N/A
Deductible
N/A
Out of Pocket Max (single/family)
N/A

Other Benefits

Vision/Dental
Pediatric Vision and Dental
Renewal Date
12/31/2025
HSA Eligible
Yes

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