Return to flip book view

BUSINESS SERVICES CORPORATION D/B/A BENEFIT CHOICES INDIVIDUAL / SOLE PROPRIETOR HEALTH INSURANCE PLANSPAGE #1 OF 210/30/2023 12:05 PM2024MVP HEALTH CARE - STANDARD PLANS FOR INDIVIDUALSOther than rates, Items in Red are changes for 2024METAL TIER PRODUCT TIERMONTHLY RATEDEDUCTIBLE (SINGLE/FAMILY)OOP MAX (SINGLE/FAMILY)OFFICE VISITSPECIALIST VISITINPATIENT HOSPITALOUTPATIENT SURGERYURGENT CAREERDIAGNOSTIC RADIOLOGY / LABDIABETIC SUPPLIESPRESCRIPTION DRUGSPLATINUMStandard Plan PREMIER PLATINUM 1 EMBEDDEDIndividual Indiv/Spouse Parent/Child(ren) Family$1,052.91 $2,105.82 $1,789.95 $3,000.79$0/$0 $2,000/$4,000 $15 $35 $500 $100 $55 $100 $35/$35 $15$0 Deductible; Copayment $10/$30/$60GOLDStandard Plan PREMIER GOLD 1 EMBEDDEDIndividual Indiv/Spouse Parent/Child(ren) Family$864.65 $1,729.30 $1,469.91 $2,464.25$600/$1,200 $5,900/$11,800 $25 $40 $1,000 $100 $60 $150 $40/$40 $25$0 Deductible; Copayment $10/$35/$70SILVERStandard Plan PREMIER SILVER 1 EMBEDDED Individual Indiv/Spouse Parent/Child(ren) Family$679.54 $1,359.08 $1,155.22 $1,936.69$2,100/$4,200 $9,450/$18,900$30 NoDD, then $30$65 NoDD $1,500 $150 $70 $500 $75/$50 $30$0 Deductible; Copayment $15/$40/$75Standard Plan PREMIER BRONZE 1 QHDHP EMBEDDED Individual Indiv/Spouse Parent/Child(ren) Family$518.02 $1,036.04 $880.63 $1,476.36$6,100/$12,200 $7,150/$14,300 50% 50% 50% 50% 50% 50% 50%/50% 50%Ded. Integrated w/Medical; Copayment $10/$35/$70Standard Plan PREMIER BRONZE 2 EMBEDDED Individual Indiv/Spouse Parent/Child(ren) Family$536.81 $1,073.62 $912.58 $1,529.91$4,600/$9,200 $9,450/$18,9003 PCP Visits @$50 NoDD, then$503 Visits @$75 NoDD, then $75$1,500 $150 $75 $500 $75/$50 5000%Ded. Integrated w/Medical; Copayment $10/$35/$70NoDD: Not subject to Deductible * Member amount after deductible is met. NOTE: In case of a discrepancy in the display of these plan details and rates, The carrier's actual plan details and rates prevail.AGGREGATE: For any policy with two or more members, the deductible must be met by any one or any combination of members before the plan makes payments.EMBEDDED: Each member must meet their individual deductible before plan makes payments. The individual deductible also applies to family deductible level. Once family deductible is met, plan begins payment of services for all contract members.WELLBEING REWARDS - Earn up to $600 per contract, per calendar year.VIRTUAL CARE: GIA virtual care services are $0 on all plans except qualified high-deductible plans. The IRA requires members enrolled in QHDHPs to pay for virtual care services until their plan deductible is met.PEDIATRIC DENTAL COVERAGE TO AGE 19 is included with all MVP New York Small Group plans. Preventative services subject to $25 co-pay (deductible applies to QHDHP), routine services subject to 20% co-insurance, and major services, including medically necessary orthodontia, are subject to a 50% co-insurance.TELEMEDICINE BENEFIT - access care anywhere, anytime on your computer, tablet or smartphone with 24/7 online doctor visits. Board-certified doctors and therapists.BRONZE

BUSINESS SERVICES CORPORATION D/B/A BENEFIT CHOICES INDIVIDUAL / SOLE PROPRIETOR HEALTH INSURANCE PLANSPAGE #2 OF 210/30/2023 12:05 PM2024MVP HEALTH CARE - NON-STANDARD PLANS FOR INDIVIDUALSOther than rates, Items in Red are changes for 2024METAL TIER PRODUCT TIERMONTHLY RATEDEDUCTIBLE (SINGLE/FAMILY)OOP MAX (SINGLE/FAMILY)OFFICE VISITSPECIALIST VISITINPATIENT HOSPITALOUTPATIENT SURGERYURGENT CAREERDIAGNOSTIC RADIOLOGY/LABDIABETIC SUPPLIESPRESCRIPTION DRUGSNon-Standard Plan PREMIER PLUS GOLD 1 EMBEDDEDIndividual Empl/Spouse Parent/Child(ren) Family$846.69 $1,693.38 $1,439.37 $2,413.07$1,200/$2,400 $5,900/$11,800 3 PCP visits @$0 NoDD Then $15 NoDD$50 $500 $200 $50 NoDD $350 NoDD $50 /$50 NoDD $15 NoDD$100/$200 Deductible (Name brand only); Copayment $10 NoDD/$40/$60Non-Standard Plan PREMIER PLUS GOLD 2 QHDHP Aggregate-EmbeddedIndividual Indiv/Spouse Parent/Child(ren Family$822.31 $1,644.62 $1,397.93 $2,343.58$1,600/$4,300 AGG $6,900/$13,800 $5 $25 $400 $100 $25 $75 $25/$25 $5Ded. Integrated w/Medical; Copayment $5/$15/$25 (preventive drugs NoDD)Non-Standard Plan PREMIER PLUS GOLD 4 EmbeddedIndividual Indiv/Spouse Parent/Child(ren Family$881.00 $1,762.00 $1,497.70 $2,150.85$0/$0 $8,000/$16,000 $40 $50 $1,000 $300 $50 $500 $50/$50 $40$0/$0 $10 NoDD/$40 NoDD/$60 NoDDNon-Standard PlanPREMIER PLUS SILVER 3 QHDHP AGGREGATE / EMBEDDEDIndividual Indiv/Spouse Parent/Child(ren) Family$684.40 $1,368.80 $1,163.48 $1,950.54$2,650/$5,300 AGG $6,200/$12,400 $30 $60 $500 $200 $60 $325 $60/$60 $30Ded. Integrated w/Medical; Copayment $10/$45/$90 (preventive drugs NoDD)Non-Standard PlanPREMIER PLUS SILVER 12 EMBEDDEDIndividual Indiv/Spouse Parent/Child(ren) Family$696.19 $1,392.38 $1,183.52 $1,984.14$3,350/$6,700 $9,260/$18,500$35 NoDD ($0 to age 26)$50 $1,000 $400 $50 NoDD $350 $150/$75 NoDD$35 Nodd ($0 to age 26)Ded. Integrated with Medical; $15 NoDD ($0 to age 26)/ $45/$90Non-Standard Plan PREMIER PLUS SILVER 13 EMBEDDEDIndividual Indiv/Spouse Parent/Child(ren) Family$676.86 $1,353.72 $1,150.66 $1,929.05$2,800/$5,600 $9,100/$18,200 $35 $50 $500 $150 $50 $250 $50/$50 NoDD $35 No Deductible $0/$10/$50Non-Standard PlanPREMIER PLUS BRONZE 2 EMBEDDEDIndividual Empl/Spouse Parent/Child(ren) Family$516.55 $1,033.10 $878.14 $1,472.17$6,400/$12,800 $8,900/$17,8003 visits @$0 NoDD, then 40%40% 40% 40% 40% 40% 40%*/40%* 40%Ded. Integrated w/Medical; Copayment $5/$60/$80Non-Standard Plan PREMIER PLUS BRONZE 3 QHDHP EMBEDDEDIndividual Empl/Spouse Parent/Child(ren) Family$516.63 $1,033.26 $878.27 $1,472.40$6,500/$13,000 $7,100/$14,200 $30 $50 30% $100 $50 $500 $50*/$50* $30 *Ded. Integrated w/Medical: Copayment $10/$45/$90 (preventive drugs NoDD)Non-Standard Plan PREMIER PLUS BRONZE 7 EMBEDDEDIndividual Empl/Spouse Parent/Child(ren) Family$502.28 $1,004.56 $853.88 $1,431.50$9,450/$18,900 $9,450/$18,900 0% 0% 0% 0% 0% 0% 0%/0% 0%Ded. Integrated w/Medical; $5 NoDD/0%/0%NoDD: Not subject to Deductible * Member amount after deductible is met. NOTE: In case of a discrepancy in the display of these plan details and rates, The carrier's actual plan details and rates prevail.AGGREGATE: For any policy with two or more members, the deductible must be met by any one or any combination of members before the plan makes payments.EMBEDDED: Each member must meet their individual deductible before plan makes payments. The individual deductible also applies to family deductible level. Once family deductible is met, plan begins payment of services for all contract members.WELLBEING REWARDS - Earn up to $600 per contract, per calendar year.VIRTUAL CARE: GIA virtual care services are $0 on all plans except qualified high-deductible plans. The IRA requires members enrolled in QHDHPs to pay for virtual care services until their plan deductible is met.PEDIATRIC DENTAL COVERAGE TO AGE 19 is included with all MVP NEW York Small Group plans. Preventative services subject to $25 co-pay (deductible applies to QHDHP), routine services subject to 20% co-insurance, and major services, including medically necessary orthodontia, are subject to a 50% co-insurance.TELEMEDICINE BENEFIT - access care anywhere, anytime on your computer, tablet or smartphone with 24/7 online doctor visits. Board-certified doctors and therapists.GOLDSILVER