Prescription $100 (Name Integrated $100 (Name Integrated Integrated $200 Integrated IntegratedDeductible brand only) with Medical brand only) with Medical with Medical with Medical with MedicalPrescription $5/$35/$70* $5/$15/$25* $8/$35/$70* $8/$35/$70* $10/$40/$60* $10/$40/50%* $8/$40/$60* $5/$40/$60*Copayment $0 generic (preventive $0 generic $0 generic (preventive $0 generic $0 generic (preventive

until age 10† drugs not until age 10† until age 10* drugs not until age 10* until age 10* drugs notsubject to subject to subject todeductible) deductible) deductible)

$0 $0 $0 $0$15 $25* $30* 50%*

$35 $40* $50* 50%*

$500 $1,000* $1,500* 50%* $100 $100* $100* 50%*$55 $60* $70* 50%*$100 $150* $150* 50%*

Preventive Care $0 $0 $0 $0 $0 $0 $0 $0 Primary Care 3 visits at $0 $5* $30 (not 3 visits at $0 $25* $35* 3 visits at $0 $30*

and then $15 subject to and then $35 and then $35 (not subject deductible) (not subject (not subject to deductible) to deductible) to deductible)

Specialist Visit $45* $15* $50* $60* $50* $80* $60* $50*Hospital Facility Visit: Inpatient $500* $200* 20%* 20%* $500* 50%* 30%* 30%*

Outpatient $200* $100* $300* $200* $200* $300* $300* $100*Urgent Care $45* $15* $50* $60 $50* $80* $60* $50*Emergency $300 (not $75* $350* $350 (not $300* 50%* $350 (not $300*Room Visit subject to subject to subject to

deductible) deductible) deductible)

Plan Deductible– $850 $1,400 $1,900 $1,500 $1,500 $3,500 $4,000 $4,000IndividualOut-of-Pocket $6,350 $6,350 $6,350 $6,350 $6,350 $6,350 $6,350 $6,350 Maximum

PLAN FEATURE PLATINUMGOLD 1 GOLD 2 HDHPAGGREGATE

MVP Premier Plus Plans (Non-Standard)METAL LEVEL

SILVER 2 SILVER 3 HDHPAGGREGATE

SILVER 1

MVP Premier Plans (Standard)METAL LEVEL

WELLNESS BENEFITS – MVP PREMIER PLANS

All New York MVP Premier Plans for Individuals include up to$600 in gym reimbursement benefits per contract and access to MVP’s suite of online wellness tools and activities.

• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •NY PREMIER IND OFF_BUFFALO (10/24/13)

PHARMACY

MEDICAL

90%PLATINUM

80%GOLD

70%SILVER

60%BRONZE

LEVELS OF COVERAGEAll health plans on the Exchange will be offered in a tiered formatbased on four metal levels that match the percentage of costscovered. As the metal level goes down, the monthly premiumgoes down while the member's out-of-pocket cost share goes up.

OUT-OF-POCKET COSTS

COST COVERED BYYOUR PREMIUM

see back for other information

$0 $600 $2,000 $3,000

$2,000 $4,000 $5,500 $6,350

BRONZE 1 BRONZE 2 BRONZE 3 HDHPEMBEDDED

$0 $0 $0 Integrated with Medical

$10/$30/$60 $10/$35/$70 $10/$35/$70 10/$35/$70*

GOLD SILVER BRONZE

WELLNESS BENEFITS – MVP PREMIER PLUS PLANS

All New York MVP Premier Plus Plans for Individuals include up to $125 per contract in reimbursement for gym and fitness clubmembership, youth sports and fitness fees or healthy weight support programs. Plans also include access to MVP’s suite of onlinewellness tools and activities.

NEW YORK PREMIER PLANS AT A GLANCEINDIVIDUAL OFF–EXCHANGE with premiums for the Buffalo Region• • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Coverage to meet your needs and help you take on life and live well!

$1,000 for out-of-area coverage‡.PREMIER PLUS PLANS

Affordable pharmacy. Convenient online resources.

‡ Per dependent child for all Premier Plus plans. Benefits are subject to the same cost sharing arrangements for each particular plan.* Member amount after deductible is met.† Generic drugs are NOT subject to deductible.“MVP Health Care” is the parent company of MVP Health Insurance Company; MVP Health Plan, Inc.; MVP Health Insurance Company ofNew Hampshire, Inc.; MVP Health Plan of New Hampshire, Inc.; MVP Select Care, Inc.; Preferred Administrative Services, Inc.; and PreferredAssurance Company, Inc., which issue or administer health benefit plans. Not all plans available in all states.

$480.42 $407.38 $338.43 $260.25$960.84 $814.76 $676.86 $520.50$816.71 $692.55 $575.33 $442.43$1,369.20 $1,161.03 $964.53 $741.71

Single $393.56 $374.28 $319.16 $329.48 $331.27 $264.35 $266.97 $254.34Single + Spouse $787.12 $748.56 $638.32 $658.96 $662.54 $528.70 $533.94 $508.68Single + Child(ren) $669.05 $636.28 $542.57 $560.12 $563.16 $449.40 $453.85 $432.38Single + Spouse + $1,121.65 $1,066.70 $909.61 $939.02 $944.12 $753.40 $760.86 $724.87Child(ren)

NEW YORK PREMIER PLANS

QUALITY BENEFITS FROM A NAME YOU KNOW AND TRUSTIn addition to quality coverage, MVP will continue to provide top-rated customer service, unique wellness options and innovative tools to all of our members.

WELLNESS BENEFITSUP TO $125 per contract in REIMBURSEMENTfor gym and fitness club membership, youthsports and fitness fees or healthy weight support programs

PERSONALIZED GUIDANCE and supportthrough MVP’s Health Management Programs,24/7 Nurse Advice Line and full suite of onlinewellness tools and resources, including a Personal Health Assessment and online health improvement classes

EXCLUSIVE MEMBER DISCOUNTS on a wide range of health and wellness services, from fitness clubs and vitamins to acupuncture and massage therapy

INTRODUCING THE myMVP MOBILE APPMVP knows you’re constantlyon the move, so we created an innovative mobile app to fit your mobile lifestyle, featuring:

• INSTANTLY ACCESS your ID card, find a doctornearby and connect withMVP

• Visit the App Store orGoogle Play to DOWNLOADthe myMVP app FOR FREEon your mobile device(MSG&DATA rates may apply)

ONLINE RX RESOURCESCheck out all of MVP’s online RX resources atmvphealthcare.com under Manage Prescriptions:

• Find your medications on the MVP Formulary

• Find a Pharmacy

• Access personalized online pharmacy services, including My Rx Choices®, the Express Scripts prescription drug comparison and savings program

MAKE THE MOST OFDiscoverMVP.com Visit DiscoverMVP.com for a variety of resources to help you make the best health insurance decisions:

• Get more information on MVP’s New York plans – including the ability to find a plan based on specific search filters

• Information on how to purchase a plan

• Ability to download and print Summary of Benefits and Coverage (SBC) for each plan

• Comprehensive Health Care Reform center with Infographics,FAQs, Insurance Terms Glossary and Blog posts

• Download the myMVP app

• MVP Community Blog

BUFFALO REGIONCounties include: • Allegany#

• Cattaraugus#

• Chautauqua#

• Erie#

• Genesee• Niagara#

• Orleans• Wyoming

PLAN FEATURE

MVP Premier Plus Plans (Non-Standard)RATES EFFECTIVE 1/1/2014 - 12/31/2014§

METAL LEVEL

MVP Premier Plans (Standard)RATES EFFECTIVE 1/1/2014 - 12/31/2014§

METAL LEVEL

PLATINUMGOLD 1 GOLD 2 HDHPAGGREGATE

SILVER 2 SILVER 3 HDHPAGGREGATE

SILVER 1 BRONZE 1 BRONZE 2 BRONZE 3 HDHPEMBEDDED

GOLD SILVER BRONZE

# MVP is not licensed to sell in this county.§ Rates do not include pediatric dental coverage.