Comprehensive Medical Coverage for Everyday and Unexpected Healthcare Needs
The Max MV Plan is our most comprehensive Minimum Value (MV) medical plan. It combines preventive care, routine healthcare services, prescription benefits, virtual care, and coverage for major medical events such as hospitalization, surgery, and emergency care.
If you're looking for a plan that provides coverage for both everyday healthcare needs and larger medical expenses, the Max MV Plan offers the broadest protection available in our benefit portfolio.
What's Included?
The Max MV Plan provides benefits for:
- Preventive care
- Primary care visits
- Specialist visits
- Urgent care
- Lab work and diagnostic testing
- Prescription medications
- Virtual care
- Hospitalization
- Surgery
- Emergency room services
- Ambulance transportation
- Maternity care
- Mental health services
- Substance abuse treatment
- Physical therapy
- Chiropractic care
- Home health care
Coverage is subject to plan limitations, copays, and annual service limits.
Preventive Care
Preventive care is covered at 100% when received from participating providers. Preventive services include annual wellness visits, screenings, immunizations, and other preventive healthcare services recommended under federal guidelines.
Examples include:
- Annual wellness exams
- Blood pressure screenings
- Cholesterol screenings
- Cancer screenings
- Immunizations
- Women's preventive services
- Children's preventive services
Doctor Visits
Primary Care and Specialist Visits
When you visit a primary care physician or specialist, your cost is:
- $15 copay per visit in-network
Out-of-network services are subject to coinsurance.
Urgent Care
For urgent medical concerns that are not emergencies:
- $50 copay per visit in-network
Examples include:
- Flu symptoms
- Minor infections
- Sprains and strains
- Minor injuries
- Fever or illness requiring same-day care
Laboratory and Diagnostic Services
The plan includes coverage for:
- Laboratory testing
- X-rays
- Ultrasounds
Your cost is:
- $50 copay in-network
MRI, CT Scans and Advanced Imaging
Advanced imaging services such as MRI, CT, and PET scans are covered with:
- $350 copay
- Limited to 3 scans per plan year
- Preauthorization required
The plan also includes access to Medmo, a concierge imaging service that helps members locate convenient, cost-effective imaging facilities.
Hospital and Surgery Benefits
One of the biggest advantages of the Max MV Plan is coverage for hospital and surgical services.
Inpatient Hospitalization
If you are admitted to a hospital:
- $500 copay per admission
- Up to 14 inpatient days per year
- Up to 4 covered surgeries per year
Outpatient Surgery
Covered with:
- $350 copay
- Up to 2 outpatient surgeries per year
Emergency Care
Emergency services are covered when unexpected medical situations arise.
Emergency Room
- $500 copay
- Limited to 1 emergency room visit per year
Ground Ambulance
- $500 copay
- Limited to 2 transports per year
Air ambulance transportation is not covered.
Maternity Benefits
The Max MV Plan includes maternity coverage.
Covered services may include:
- Prenatal office visits
- Laboratory services
- Ultrasounds
- Delivery-related professional services
- Inpatient maternity hospitalization
Professional maternity services are subject to a $350 copay and inpatient admissions are subject to a $500 copay per admission.
Mental Health and Substance Abuse Benefits
The plan includes both inpatient and outpatient behavioral health services.
Mental Health Services
- Outpatient mental health visits are covered similarly to specialist visits
- Inpatient mental health treatment covered up to 14 days per year
Substance Abuse Treatment
- Outpatient treatment: $75 copay
- Inpatient treatment: $500 copay per admission
- Up to 14 inpatient days per year
- Up to 12 outpatient treatment days per year
Therapy, Chiropractic and Home Health Care
The Max MV Plan includes additional recovery and rehabilitation benefits.
Physical, Occupational and Speech Therapy
- $50 copay
- 12 combined visits per year
Chiropractic Care
- $50 copay
- 20 visits per year
Home Health Care
- $50 copay
- 20 days per year
Prescription Drug Coverage
The Max MV Plan provides one of the strongest prescription benefits available in the portfolio.
| Prescription Tier | Member Cost |
|---|---|
| Tier 1 Generic | $10 Copay |
| Tier 2 Generic & Preferred Brand | $50 Copay |
| Tier 3 Generic & Non-Preferred Brand | $75 Copay |
| Specialty Drugs | Discount Only |
Certain medications may require prior authorization. Specialty medications and GLP-1 medications are generally not covered under the prescription benefit.
Virtual Care Included at No Cost
All members have access to Recuro Health Virtual Care.
Virtual Urgent Care
Available 24/7 for:
- Cold and flu symptoms
- Allergies
- Skin conditions
- Respiratory concerns
- Gastrointestinal issues
- Minor illnesses
Virtual Behavioral Health
Access licensed counselors virtually for:
- Anxiety
- Depression
- Stress management
- Grief and loss
- Marriage counseling
- Other behavioral health concerns
Member Cost:
- $0 Copay
Important Things to Know
Some services require preauthorization, including:
- MRI, CT and PET scans
- Inpatient hospitalization
- Surgery
- Maternity admissions
- Residential treatment programs
Failure to obtain required preauthorization may result in reduced or denied benefits.
Certain services are not covered, including:
- Chemotherapy and radiation therapy
- Dialysis
- Organ transplants
- Durable medical equipment
- Vision care
- Dental care
- Hospice care
- Specialty prescription drugs
- GLP-1 injectable medications
Quick Summary
The Max MV Plan is designed for employees who want the broadest medical coverage available in the MV portfolio.
Key highlights include:
✓ $0 deductible
✓ $15 primary care and specialist visits
✓ Hospitalization and surgery coverage
✓ Emergency room and ambulance benefits
✓ Maternity benefits
✓ Enhanced prescription coverage
✓ Mental health and substance abuse treatment
✓ Physical therapy and chiropractic coverage
✓ Unlimited virtual urgent care
✓ Unlimited virtual behavioral health access
For employees seeking the most comprehensive balance of routine healthcare and major medical protection, the Max MV Plan provides the highest level of coverage available within the MV plan family.