Forms
Collateral
Download Helpful Information for You and Your Employees
- Medicare Advantage Employer Handbook (PDF)—Information to help manage Medicare Advantage health plans, including the ABC’s of Medicare, eligibility, enrollment and billing
- MVP Core Analytics (PDF)—Introducing MVP’s new reporting tool for qualifying employers
- MVP Wellness Features (PDF)—An overview of online wellness tools and activities and programs to help your employees reach their health improvement goals
- myMVP Mobile App (PDF)—An overview of MVP’s member app, providing access to important health plan information
- Pharmacy Benefits Overview (PDF)—A general summary of MVP’s 2017 pharmacy benefits and Pharmacy Benefits Manager, CVS/caremark®
- myVisitNow—24/7 Online Doctor Visits (PDF)—Key features of the new 2017 telemedicine benefit, that allows members to access health care professionals from a computer, tablet, or smartphone.
- Treatment Cost Calculator (PDF)—An overview of MVP’s treatment calculator, helping employees search, review, and compare health services
Creditable Coverage
2017 Creditable Coverage Materials
2016 Creditable Coverage Materials
Forms
2017 Enrollment/Change Forms
Download forms to enroll, make changes or cancel a health plan subscriber.
- 2017 Dental Enrollment/Change Form—Small Group (PDF)
- 2017 Enrollment/Change Form—NY Large Group (PDF)
- 2017 Enrollment/Change Form—NY Small Group (PDF)
- 2017 Enrollment/Change Form—VT Large Group (PDF)
- 2017 Small Group Application – NY (PDF)
- 2017 Small Group Application - VT (PDF)
- 2017 Group Medicare Enrollment Form (PDF)
2016 Enrollment/Change Forms
Download forms to enroll, make changes or cancel a health plan subscriber.
- 2016 Dental Enrollment/Change Form—Small Group (PDF)
- 2016 Enrollment/Change Form—Group Medicare (PDF)
- 2016 Enrollment/Change Form—NY Large Group (PDF)
- 2016 Enrollment/Change Form—NY Small Group (PDF)
- 2016 Enrollment/Change Form—VT Large Group (PDF)
Product Placemats
2017 NY Small Group Off-Exchange Product Placemats
Download regional summaries of benefits and rates for Small Group Off-Exchange (Liberty) plans. Rates effective July 1, 2017 – September 30, 2017.
- Q3 2017 NY Liberty Plans—Albany (Off) (PDF)
- Q3 2017 NY Liberty Plans—Buffalo (Off) (PDF)
- Q3 2017 NY Liberty Plans—Mid-Hudson (Off) (PDF)
- Q3 2017 NY Liberty Plans—New York City (Off) (PDF)
- Q3 2017 NY Liberty Plans—Rochester (Off) (PDF)
- Q3 2017 NY Liberty Plans—Syracuse (Off) (PDF)
- Q3 2017 NY Liberty Plans—Utica/Watertown (Off) (PDF)
Download regional summaries of benefits and rates for Small Group Off-Exchange (Liberty) plans. Rates effective October 1, 2017 – December 31, 2017.
- Q4 2017 NY Liberty Plans—Albany (Off) (PDF)
- Q4 2017 NY Liberty Plans—Buffalo (Off) (PDF)
- Q4 2017 NY Liberty Plans—Mid-Hudson (Off) (PDF)
- Q4 2017 NY Liberty Plans—New York City (Off) (PDF)
- Q4 2017 NY Liberty Plans—Rochester (Off) (PDF)
- Q4 2017 NY Liberty Plans—Syracuse (Off) (PDF)
- Q4 2017 NY Liberty Plans—Utica/Watertown (Off) (PDF)
2017 NY Small Group On-Exchange Product Placemats
Download regional summaries of benefits and rates for Small Group On-Exchange (Premier) plans. Rates effective July 1, 2017 – September 30, 2017.
- Q3 2017 NY Premier Plans—Albany (On) (PDF)
- Q3 2017 NY Premier Plans—Buffalo (On) (PDF)
- Q3 2017 NY Premier Plans—Mid-Hudson (On) (PDF)
- Q3 2017 NY Premier Plans—New York City (On) (PDF)
- Q3 2017 NY Premier Plans—Rochester (On) (PDF)
- Q3 2017 NY Premier Plans—Syracuse (On) (PDF)
- Q3 2017 NY Premier Plans—Utica/Watertown (On) (PDF)
Download regional summaries of benefits and rates for Small Group On-Exchange (Premier) plans. Rates effective October 1, 2017 – December 31, 2017.
- Q4 2017 NY Premier Plans—Albany (On) (PDF)
- Q4 2017 NY Premier Plans—Buffalo (On) (PDF)
- Q4 2017 NY Premier Plans—Mid-Hudson (On) (PDF)
- Q4 2017 NY Premier Plans—New York City (On) (PDF)
- Q4 2017 NY Premier Plans—Rochester (On) (PDF)
- Q4 2017 NY Premier Plans—Syracuse (On) (PDF)
- Q4 2017 NY Premier Plans—Utica/Watertown (On) (PDF)
2017 VT Small Group and Individual Product Placemat
Download a summary of benefits and rates for Small Group and Individual plans. Rates effective January 1, 2017 – December 31, 2017.