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Premier Plus Gold 2 HDHP HSA by MVP

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Plan Information

Plan Name
Premier Plus Gold 2 HDHP HSA
Insurance Company
MVP

In Network Benefits

Office Co-pay
$5 after deductible
Specialist Co-pay
$25 after deductible
Hospital Co-pay
$400 after deductible
Emergency Room
$75 after deductible
Referrals Needed
No
Rx: Generic/Brand/High Brand
$5/$15/$25 all after deductible
In-Network Deductible (single/family)
$1,650 / $3,300
In-Network Co-Insurance
N/A
Max Out of Pocket (single/family)
$6,900 / $13,800

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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