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Premier Silver 1 by MVP

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Plan Information

Plan Name
Premier Silver 1
Insurance Company
MVP

In Network Benefits

Office Co-pay
$30 after deductible
Specialist Co-pay
$65 after deductible
Hospital Co-pay
$1,500 after deductible
Emergency Room
$500 after deductible
Referrals Needed
No
Rx: Generic/Brand/High Brand
$15/$40/$75
In-Network Deductible (single/family)
$2,100 / $4200
In-Network Co-Insurance
N/A
Max Out of Pocket (single/family)
$9,200 / $18,400

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
No

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