Medical Coverage for Routine Care and Unexpected Health Events
The Essential MV Plan is designed to provide access to preventive care, doctor visits, virtual care, prescription benefits, and protection against larger medical expenses such as hospitalization, emergency services, and surgery.
The plan combines routine healthcare benefits with coverage for unexpected medical events, helping employees and their families access important healthcare services while maintaining affordable monthly costs.
What's Included?
The Essential MV Plan provides benefits for:
- Preventive care
- Primary care visits
- Specialist visits
- Urgent care
- Laboratory testing
- Diagnostic imaging
- Hospitalization
- Surgery
- Emergency room services
- Ground ambulance transportation
- Maternity care
- Mental health services
- Substance abuse treatment
- Prescription drug benefits
- Virtual urgent care
- Virtual behavioral health
Coverage is subject to plan limitations, copays, annual maximums, and preauthorization requirements.
Preventive Care
Preventive services are covered when received from participating providers.
Examples include:
- Annual wellness visits
- Routine screenings
- Cancer screenings
- Immunizations
- Women's preventive care
- Children's preventive care
Preventive care is designed to help identify health concerns early and support long-term wellness.
Doctor Visits
Primary Care Visits
Primary care physicians can help with:
- Routine healthcare concerns
- Minor illnesses
- Preventive care follow-up
- Ongoing health conditions
- Prescription management
Specialist Visits
Specialist care may include visits to:
- Cardiologists
- Dermatologists
- Orthopedic specialists
- Gastroenterologists
- Other medical specialists
Refer to your Summary of Benefits for the applicable copay or coinsurance amount for physician visits.
Urgent Care
Urgent care benefits are available for non-emergency medical situations.
Examples include:
- Flu symptoms
- Ear infections
- Minor injuries
- Fever
- Minor cuts and burns
- Sprains and strains
Urgent care can often be a lower-cost alternative to an emergency room visit.
Laboratory and Imaging Services
The Essential MV Plan includes benefits for many common diagnostic services.
Examples include:
- Blood tests
- Laboratory testing
- X-rays
- Ultrasounds
- Other diagnostic procedures
Certain advanced imaging services, such as MRI, CT, or PET scans, may require preauthorization and may be subject to annual limits.
Hospital and Surgery Benefits
One of the key advantages of an MV plan is coverage for major medical events.
Hospitalization
If you are admitted to a hospital for a covered medical condition, the plan provides benefits for inpatient hospital services subject to plan limitations.
Surgery
Covered surgical procedures may include both inpatient and outpatient surgeries when medically necessary.
Preauthorization requirements may apply.
Emergency Care
Emergency services are available for serious and unexpected medical conditions.
Examples include:
- Chest pain
- Serious injuries
- Severe illness
- Difficulty breathing
- Emergency medical situations
Emergency room and ambulance services are subject to the plan's copays, limits, and coverage provisions.
Maternity Benefits
The Essential MV Plan includes maternity benefits.
Covered services may include:
- Prenatal office visits
- Laboratory testing
- Ultrasounds
- Delivery-related professional services
- Inpatient maternity hospitalization
Coverage is subject to applicable plan copays and limitations.
Mental Health and Substance Abuse Benefits
The plan includes benefits for behavioral health services.
Virtual Behavioral Health
Members have access to licensed counselors through Recuro Health at no additional cost.
Examples include:
- Anxiety
- Depression
- Stress management
- Grief and loss
- Relationship concerns
Additional Mental Health Services
The plan may also provide benefits for covered in-person mental health and substance abuse treatment services.
Prescription Drug Benefits
The Essential MV Plan includes prescription benefits for covered medications.
Covered medications and member costs are determined by the plan formulary.
Depending on the medication prescribed, different copays or discounts may apply.
Always review your prescription benefit information to understand which medications are covered and what your cost may be.
Virtual Care Included
The Essential MV Plan includes access to Recuro Health virtual care services.
Virtual Urgent Care
Available 24 hours a day, 7 days a week for common medical concerns such as:
- Cold and flu symptoms
- Allergies
- Skin conditions
- Respiratory illnesses
- Gastrointestinal concerns
Virtual Behavioral Health
Connect with licensed counselors through secure video or phone appointments.
Your Cost
- $0 Copay
These services provide convenient access to care from home, work, or while traveling.
Important Things to Know
Some services may require preauthorization before care is received.
Examples may include:
- Hospital admissions
- Surgery
- Advanced imaging
- Certain specialty treatments
Failure to obtain required preauthorization may result in reduced or denied benefits.
Always review your plan documents or contact customer service before receiving major medical services.
Services Generally Not Covered
Like all health plans, certain services may not be covered.
Examples may include:
- Cosmetic procedures
- Experimental treatments
- Certain specialty medications
- Dental services
- Vision services
- Long-term care
Refer to your Summary of Benefits and Plan Document for a complete list of exclusions and limitations.
Quick Summary
The Essential MV Plan provides coverage for both routine healthcare needs and larger medical events.
Key highlights include:
✓ Preventive care
✓ Doctor visits
✓ Specialist visits
✓ Urgent care
✓ Hospitalization benefits
✓ Surgery benefits
✓ Emergency room coverage
✓ Maternity benefits
✓ Prescription drug benefits
✓ Virtual urgent care
✓ Virtual behavioral health
✓ Mental health and substance abuse benefits
For employees looking for affordable medical coverage that includes protection against major medical expenses, the Essential MV Plan provides a strong foundation of healthcare benefits for individuals and families.