Major Medical Coverage with a High Deductible
The MV 6500 Plan is a Minimum Value (MV) medical plan that combines preventive care, doctor visits, hospital coverage, emergency services, prescription benefits, and virtual care.
Unlike some other plans that use fixed copays for most services, the MV 6500 includes a deductible. This means that for many services, you will pay the cost of care until your deductible is met, after which the plan begins sharing costs with you.
Understanding the Deductible
The most important feature of the MV 6500 plan is its deductible.
Annual Deductible
- Individual: $6,500
- Family: $13,200
Out-of-Pocket Maximum
- Individual: $6,500
- Family: $13,200
For many covered services, once the deductible has been satisfied, the plan pays 60% of covered expenses and you are responsible for the remaining 40%.
What's Included?
The MV 6500 Plan provides benefits for:
- Preventive care
- Primary care visits
- Specialist visits
- Urgent care
- Emergency room services
- Laboratory testing
- X-rays
- MRI, CT, and advanced imaging
- Hospitalization
- Surgery
- Prescription medications
- Virtual doctor visits
- Virtual behavioral health
Coverage varies depending on the service received.
Preventive Care
Preventive services are covered at 100%.
Examples include:
- Annual wellness visits
- Preventive screenings
- Immunizations
- Women's preventive care
- Children's preventive care
Preventive care is not subject to the deductible.
Doctor Visits
Primary Care Visits
Primary care visits are covered even before your deductible is met.
Your Cost
- $50 copay
- After the visit copay, the plan pays 60% of covered charges
Examples include:
- Routine illnesses
- Follow-up visits
- Prescription management
- General healthcare concerns
Specialist Visits
Specialist visits are also available before meeting your deductible.
Your Cost
- $70 copay
- After the visit copay, the plan pays 60% of covered charges
Examples include:
- Dermatology
- Cardiology
- Orthopedics
- Gastroenterology
Urgent Care and Emergency Services
The MV 6500 plan includes both urgent care and emergency room benefits.
Your Cost
After your deductible is met:
- Plan pays 60%
- You pay 40%
Examples include:
- Urgent care visits
- Emergency room visits
- Non-routine emergency treatment
Emergency transportation is covered separately and subject to plan limitations.
Laboratory Testing and Diagnostic Imaging
The plan includes benefits for:
- Blood work
- Laboratory testing
- X-rays
- Ultrasounds
- MRI scans
- CT scans
- Other advanced imaging
Your Cost
After your deductible is met:
- Plan pays 60%
- You pay 40%
Certain imaging services may require preauthorization.
Hospital and Surgery Benefits
The MV 6500 plan provides benefits for major medical events.
Hospitalization
Covered services include:
- Inpatient hospital admissions
- Outpatient hospital services
- Physician fees related to hospitalization
Surgery
Covered services include:
- Inpatient surgery
- Associated physician services
Your Cost
After your deductible is met:
- Plan pays 60%
- You pay 40%
Preauthorization may be required for certain services.
Prescription Drug Coverage
The MV 6500 includes prescription drug benefits.
Generic Prescription Drugs
Covered 60% after the deductible is met.
Brand Prescription Drugs
Covered 60% after the deductible is met.
Non-Formulary and Specialty Drugs
Not covered.
This differs from some other plans that use fixed prescription copays.
Included Virtual Care Benefits
The MV 6500 includes Freshbenies virtual healthcare services.
Virtual Doctor Visits
Talk with a licensed U.S.-based physician from your phone, tablet, or computer.
Your Cost
- $0 Cost
Common reasons members use virtual care include:
- Cold and flu symptoms
- Allergies
- Skin conditions
- Minor illnesses
- Medication questions
When medically appropriate, prescriptions can be written electronically.
Finding a Doctor
The MV 6500 uses the PHCS Practitioner & Ancillary Network.
You can search for participating providers through:
- PHCS / MultiPlan provider search
- Your member portal
- Customer service
Using participating providers can help reduce your healthcare costs.
Important Things to Know
Certain services require preauthorization, including:
- Advanced imaging
- Hospital admissions
- Surgery
Failure to obtain required preauthorization may result in reduced or denied benefits.
Some hospital and facility services use Reference-Based Pricing (RBP). Under this arrangement, providers may bill amounts above what the plan pays, which could result in additional member responsibility beyond normal cost sharing.
Quick Summary
Included
✓ Preventive care covered at 100%
✓ Primary care visits
✓ Specialist visits
✓ Urgent care
✓ Emergency room services
✓ Hospitalization
✓ Surgery
✓ MRI and CT scans
✓ Prescription drug coverage
✓ Virtual doctor visits
Key Plan Features
✓ $6,500 individual deductible
✓ $13,200 family deductible
✓ Plan pays 60% of covered services after deductible
✓ Generic and brand-name prescription coverage
✓ $0 virtual doctor visits through Freshbenies
The MV 6500 Plan is designed for employees who want comprehensive major medical coverage, including hospitalization, surgery, emergency services, and prescription benefits, while accepting a higher deductible in exchange for lower monthly premium costs.