Affordable Medical Coverage for Everyday Healthcare and Unexpected Medical Needs
The Premium MV Plan is designed to provide access to preventive care, doctor visits, virtual care, hospitalization benefits, emergency services, and prescription coverage at an affordable cost.
The plan combines routine healthcare benefits with protection against unexpected medical events, helping you manage healthcare expenses while maintaining access to essential services.
What's Included?
The Premium MV Plan provides benefits for:
- Preventive care
- Primary care visits
- Specialist visits
- Urgent care
- Laboratory testing
- X-rays and diagnostic imaging
- Hospitalization
- Surgery
- Emergency room services
- Ground ambulance transportation
- Maternity care
- Mental health services
- Substance abuse treatment
- Physical therapy
- Chiropractic care
- Home health care
- Generic prescription medications
- Virtual urgent care
- Virtual behavioral health
Coverage is subject to plan limitations, copays, annual maximums, and preauthorization requirements.
Preventive Care
Preventive services are covered at 100% when received from participating providers.
Examples include:
- Annual wellness exams
- Immunizations
- Cancer screenings
- Cholesterol screenings
- Blood pressure screenings
- Women's preventive care
- Children's preventive care
Using preventive care is one of the best ways to stay healthy and identify potential issues early.
Doctor Visits
Primary Care and Specialist Visits
When you visit a primary care physician or specialist:
- $15 copay per visit
Examples include:
- Routine illnesses
- Follow-up appointments
- Specialist consultations
- Ongoing condition management
Urgent Care
For non-emergency medical concerns:
- $50 copay per visit
Examples include:
- Flu symptoms
- Minor infections
- Ear infections
- Sprains and strains
- Minor injuries
Laboratory and Imaging Services
Lab Work and X-Rays
Covered with:
- $50 copay
Examples include:
- Blood work
- Urinalysis
- Diagnostic testing
- X-rays
- Ultrasounds
MRI, CT and PET Scans
Advanced imaging is covered with:
- $350 copay
- Limited to 2 scans per plan year
- Preauthorization required
The plan also includes access to Medmo, a concierge imaging service that helps members locate convenient, lower-cost imaging facilities.
Hospital and Surgery Benefits
Premium MV includes coverage for major medical events requiring hospitalization or surgery.
Inpatient Hospitalization
Covered with:
- $500 copay per admission
- Up to 7 inpatient days per year
- Up to 3 surgeries per year
Outpatient Surgery
Covered with:
- $350 copay
- Limited to 1 outpatient surgery per year
These benefits can help reduce costs associated with unexpected medical procedures and hospital stays.
Emergency Care
Emergency Room
Covered with:
- $500 copay
- Limited to 1 emergency room visit per year
Ground Ambulance
Covered with:
- $500 copay
- Limited to 1 transport per year
Emergency air transportation is not covered under the plan.
Maternity Benefits
The Premium MV Plan includes maternity coverage.
Covered services may include:
- Prenatal office visits
- Laboratory testing
- Ultrasounds
- Professional maternity services
- Inpatient maternity hospitalization
Professional maternity services are subject to a $350 copay, while inpatient maternity admissions are subject to a $500 copay per admission.
Mental Health and Substance Abuse Benefits
Behavioral health support is included through both virtual and in-person options.
Virtual Behavioral Health
Available through Recuro Health at:
- $0 copay
Members have access to licensed counselors for concerns such as:
- Anxiety
- Depression
- Stress management
- Grief and loss
- Marriage counseling
In-Person Mental Health Visits
Covered under the same benefit structure as specialist visits.
Substance Abuse Treatment
Outpatient treatment:
- $75 copay
- Limited to 8 visits per year
Inpatient treatment:
- $500 copay per admission
- Limited to 7 days per year
Physical Therapy and Recovery Services
Physical, Speech and Occupational Therapy
Covered with:
- $50 copay
- 12 combined visits per year
Chiropractic Care
Covered with:
- $50 copay
- 10 visits per year
Home Health Care
Covered with:
- $50 copay
- 10 days per year
Prescription Drug Coverage
The Premium MV Plan provides coverage for generic prescription medications.
| Prescription Type | Member Cost |
|---|---|
| Tier 1 Generic Drugs | $10 Copay |
| Preferred Brand Drugs | Discount Only |
| Non-Preferred Brand Drugs | Discount Only |
| Specialty Drugs | Discount Only |
The plan is designed to encourage use of lower-cost generic medications whenever possible.
Certain medications, including GLP-1 drugs and specialty medications, are not covered under the prescription benefit and may be available only at the member's full expense.
Included Virtual Care Benefits
All members have access to Recuro Health virtual care services.
Virtual Urgent Care
Available 24 hours a day, 7 days a week for:
- Colds and flu
- Allergies
- Rashes
- Respiratory concerns
- Gastrointestinal issues
- UTIs and other common conditions
Virtual Behavioral Health
Connect with licensed counselors virtually from anywhere.
Member Cost:
- $0 Copay
These services provide convenient access to care without leaving home.
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 denied benefits.
The plan uses Reference-Based Pricing (RBP) for certain hospital and facility services. This means providers may bill amounts above what the plan pays, potentially resulting in additional member responsibility.
Services Not Covered
Some commonly requested services are not covered under Premium MV, including:
- Chemotherapy
- Radiation therapy
- Dialysis
- Organ transplants
- Durable medical equipment
- Prosthetics and orthotics
- Hospice care
- Vision care
- Dental care
- Infertility treatment
- Bariatric surgery
- Specialty prescription drugs
- GLP-1 medications
Quick Summary
The Premium MV Plan is designed for employees looking for affordable medical coverage that includes both routine healthcare and protection against larger medical events.
Key highlights include:
✓ $0 deductible
✓ $15 doctor and specialist visits
✓ Hospitalization and surgery coverage
✓ Emergency room benefits
✓ Maternity coverage
✓ Generic prescription coverage
✓ $0 virtual urgent care
✓ $0 virtual behavioral health
✓ Mental health and substance abuse treatment benefits
✓ Preventive care covered at 100%
For employees seeking affordable access to healthcare services while maintaining protection from unexpected medical expenses, Premium MV offers a balanced and cost-effective solution.