MVP Plans
MVP Lite™
Minimum Value Plan with Cost-Controlled Hospital Coverage — a flexible ACA Minimum Value solution designed for employers seeking affordable compliance and essential benefits.
MVP Lite™
Minimum Value Plan with Cost-Controlled Hospital Coverage
MVP Lite™ provides employers with an affordable Minimum Value Plan (MVP) solution designed to help satisfy ACA Minimum Value requirements while offering employees access to meaningful healthcare benefits.
Built for employers seeking a cost-effective alternative to traditional major medical plans, MVP Lite™ combines preventive care, physician access, telehealth, diagnostics, prescription benefits, and essential hospital coverage in a streamlined benefit design.
MVP Lite™ uses a cost-conscious hospital benefit structure, limiting inpatient hospitalization and surgery coverage while maintaining access to important healthcare services — helping employers balance ACA compliance, affordability, and workforce benefit needs.
With a defined benefit structure, transparent cost-sharing, and Reference-Based Pricing (RBP) strategies for select services, MVP Lite™ helps employers manage healthcare expenses while providing employees with access to essential medical care.
Plan snapshot
- Ideal size
- 5+ employees
- Annual Deductible
- $1,500 individual · $3,000 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 Lite™
ACA Minimum Value Plan
Structured as a Qualified Health Plan meeting ACA Minimum Value standards to support ALE employer mandate strategies.
Cost-Controlled Design
Defined copays, utilization limits, and Reference-Based Pricing help employers manage healthcare spend.
Everyday Healthcare Access
Preventive care, primary and specialist visits, urgent care, labs, imaging, and telehealth included.
Essential Hospital Coverage
Inpatient, outpatient surgery, ER, and maternity benefits with RBP pricing and defined utilization limits.
Physician & diagnostic
Everyday care with predictable copays
MVP Lite™ delivers accessible primary, specialty, urgent, and diagnostic care with defined member cost-sharing — no surprises 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)$350 Copay
Cost-controlled hospital benefits
Reference-Based Pricing hospital structure
MVP Lite™ 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
$250 Copay after deductibleLimited to 1 procedure per year · Precertification required
Inpatient Hospitalization & Surgery
$500 Copay per admission after deductibleUp to 5 inpatient days per year · Up to 2 surgeries per year · Precertification required
Emergency Services
$500 CopayLimited to 1 occurrence per year
Ambulance (Ground)
$500 CopayLimited to 1 per year
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 · 8 combined visits/year
- Chiropractic Services$50 Copay · 10 visits/year
- Home Health Care$50 Copay · 10 visits/year
- Substance Abuse — Outpatient$75 Copay (RBP applies)
- Substance Abuse — Inpatient$500 Copay/admission · 5 days/year
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
Defined cost-sharing for professional and inpatient facility services with precertification requirements.
- Professional Services$350 Copay
- Inpatient Facility$1,500 / admission
Employer advantages
- Streamlined Minimum Value solution designed to control healthcare costs
- Supports ACA employer mandate strategies for ALEs
- Defined copays, utilization limits, and RBP for predictable plan costs
- Pairs with MEC to build complete Penalty A & B compliance solutions
- Attractive alternative to high-cost traditional major medical plans
Member advantages
- Preventive care at no cost
- Telehealth services included
- Affordable physician and specialist visits
- Urgent care coverage
- Diagnostic and laboratory services
- Hospital protection for significant medical events
- Prescription drug benefits
Pair MVP Lite™ with a compliance strategy
MVP Lite™ can be combined with MEC plans and penalty-prevention strategies to build a complete ACA compliance solution.
MVP Lite™ FAQs
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Plan Disclosure: MVP Lite™ is designed to provide Minimum Value coverage while using a limited benefit structure to control costs. The plan includes specific limitations on certain benefits, including inpatient hospitalization and surgery, and may utilize Reference-Based Pricing for certain services. It is not equivalent to an unlimited traditional major medical plan. Employers and members should review the SBC and official plan documents for deductibles, limitations, exclusions, and cost-sharing. In the event of any discrepancy, the official plan documents shall govern.