MVP Plans
MVP Max™
Enhanced Minimum Value Plan with Expanded Hospital Coverage — a comprehensive ACA Minimum Value solution designed for employers seeking stronger benefits and cost control.
MVP Max™
Enhanced Minimum Value Plan with Expanded Hospital Coverage
MVP Max™ provides employers with an enhanced Minimum Value Plan (MVP) solution designed to support ACA Minimum Value requirements while offering employees a richer level of healthcare coverage.
Designed for employers seeking a balance between affordability and comprehensive benefits, MVP Max™ provides $0 deductible coverage, expanded hospital benefits, enhanced utilization limits, and broader access to essential healthcare services.
Compared with MVP Lite™, MVP Max™ provides a higher level of protection through increased hospital coverage, additional inpatient days, expanded surgery limits, and enhanced benefit maximums — while maintaining a cost-conscious plan structure.
With predictable copays, Reference-Based Pricing (RBP) for select services, and a defined benefit design, MVP Max™ helps employers provide meaningful coverage while maintaining greater control over healthcare spending.
Plan snapshot
- Ideal size
- 5+ employees
- Annual Deductible
- $0 individual · $0 family
- Out-of-Pocket Max
- $9,100 individual · $18,200 family
- Hospital Pricing
- Reference-Based Pricing (RBP)
- ACA Standard
- Minimum Value Plan (MVP)
Key Features of MVP Max™
ACA Minimum Value Plan
Structured as a Qualified Health Plan meeting ACA Minimum Value standards to support ALE employer mandate strategies.
$0 Deductible Coverage
Employees access physician visits, diagnostics, and hospital benefits with no annual deductible to meet.
Enhanced Everyday Benefits
Preventive care, primary and specialist visits, urgent care, imaging, telehealth, and prescriptions included.
Expanded Hospital Coverage
More inpatient days, additional surgeries, richer maternity, and comprehensive ER benefits via RBP.
Physician & diagnostic
Rich everyday care with no deductible
MVP Max™ delivers primary, specialty, urgent, and diagnostic care with $0 deductible and predictable copays — employees pay their copay and nothing more at the point of service.
- Preventive CareCovered at 100%
- Primary Care Visits$15 Copay
- Specialist Visits$15 Copay
- Urgent Care$50 Copay
- Lab Services & X-Ray$50 Copay
- Advanced Imaging (MRI/CT/PET) · 2/yr$350 Copay
Expanded hospital coverage
Reference-Based Pricing hospital structure
MVP Max™ uses Reference-Based Pricing (RBP) for select hospital services. RBP establishes reimbursement based on a defined percentage of Medicare allowable rates, helping employers manage hospital costs while improving pricing transparency.
Outpatient Surgery
$350 CopayLimited to 1 procedure per year · Precertification required
Inpatient Hospitalization & Surgery
$500 Copay per admissionUp to 7 inpatient days per year · Up to 3 surgeries per year · Precertification required
Emergency Services
$500 CopayLimited to 1 occurrence per year
Ambulance (Ground)
$500 CopayLimited to 1 per year · RBP applies
Out-of-pocket maximum applies to covered services. Certain Reference-Based Pricing services may involve additional member responsibility if provider charges exceed plan reimbursement limits.
Additional Benefits
- Physical, Speech & Occupational Therapy$50 Copay · 12 combined visits/year
- Chiropractic Services$50 Copay · 10 visits/year
- Home Health Care$50 Copay · 10 visits/year
- Substance Abuse — Outpatient$75 Copay · 8 visits/year (RBP applies)
- Substance Abuse — Inpatient$500 Copay/admission · 7 days/year (RBP applies)
Prescription Drug Benefits
Formulary-based pharmacy program with defined generic pricing and discount pricing on higher tiers.
- Generic Drugs (Tier 1)$10 Copay
- Higher-tier generics & preferred brandsDiscount Pricing
- Non-preferred & specialty medicationsDiscount Pricing
Subject to applicable formulary and supply limits.
Maternity Benefits
Enhanced maternity coverage with defined cost-sharing and precertification requirements.
- Professional Services$350 Copay
- Inpatient Facility (RBP)$500 / admission
Employer advantages
- Stronger benefit offering while maintaining a cost-controlled MVP structure
- $0 deductible and expanded hospital benefits support recruitment and retention
- Supports ACA employer mandate strategies for Applicable Large Employers
- Predictable copays, utilization limits, and RBP for improved cost visibility
- Pairs with MEC to build complete Penalty A & B compliance solutions
Member advantages
- $0 deductible coverage
- Preventive care at no cost
- Affordable physician and specialist visits
- Urgent care coverage
- Diagnostic testing and advanced imaging
- Expanded hospital protection
- Maternity benefits
- Prescription drug benefits
- Telehealth services
Pair MVP Max™ with a compliance strategy
MVP Max™ can be combined with MEC plans and penalty-prevention strategies to build a complete ACA compliance solution.
MVP Max™ FAQs
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Plan Disclosure: MVP Max™ is designed to provide Minimum Value coverage for purposes of applicable ACA Employer Shared Responsibility requirements. It is not necessarily equivalent to a traditional comprehensive major medical plan and may contain specific benefit limitations, exclusions, provider reimbursement provisions, or other restrictions. Minimum Value status, affordability, and ACA compliance should be evaluated based on the specific plan design, employer contribution, and applicable law. In the event of any discrepancy, the official plan documents shall govern.