Michigan HMO/POS/PPO Health Insurance Comparison Chart

Pricing for our health insurance plans is not shown here because it is negotiated with individual employers. What employers and employees pay will depend on factors like:

• Number of covered employees and dependents
• Ages of covered persons
• The employer's additions and deletions to standard benefits

Feature	PriorityHMOSM	PriorityPOSSM	PriorityPPOSM
Do members choose a primary care physician or other primary care provider (PCP)?	Yes. Each member chooses a PCP.	Yes. Each member chooses a PCP. No (Alternate Benefit level)	No
Do members need a referral to see a specialist?	Priority Health doesn't require that members have referrals to see specialists in our network. However, some specialists require referrals from a member's treating physician.	Yes, to receive coverage at the Preferred Benefits* level. Preferred Benefits apply even if the referral is made to an out-of-network specialist. Alternate Benefits* apply if a specialist is seen without the PCP's approval.	No. However, the Non-Network Benefits** level applies for visits to non-network physicians, even if referred by a network physician.
Do members use a provider network?	Yes (Priority Health)	Yes (Priority Health)	Yes (Priority Health and/or partner network)
Can members go to out-of-network health care providers?	No	Yes	Yes
Do members have to meet deductibles before coverage begins?	Optional	Optional (Preferred Benefits* level) Yes (Alternate Benefits* level)	Optional (Network Benefits** level) Yes (Non-Network Benefits** level)
Do members pay coinsurance?	Optional	Optional (Preferred Benefit level) Yes (Alternate Benefits level)	Optional (Network Benefits** level) Yes (Non-Network Benefits** level)
Do members pay copays?	Yes	Yes	Yes
Are prescription drugs covered?	Yes (optional)	Yes (optional)	Yes (optional)
Are maternity benefits included?	Yes	Yes	Yes (optional)
Is there a maximum benefit?	No	No. However, the Out-of-Network maximum is usually $500,000.	Yes. The maximum is typically $2 million to $5 million.
Are charges subject to reasonable & customary limits?	No	Yes (Alternate Benefits* level)	Yes (Non-Network Benefits** level)
Are HealthyEncountersSMwellness classes included?	Yes, free at PH offices; other classes are available.	Yes, free at PH offices; other classes are available.	Yes, free at PH offices; other classes are available.
Is there an approved drug list (formulary)?	Yes (closed)	Yes (closed)	Yes (closed)
What funding options are available?	Fully funded Self-funded	Fully funded Self-funded	Fully funded Self-funded
Is there national coverage?	Yes, for urgent and emergency care.	Yes, for urgent and emergency care, at the Alternate Benefits level for out-of-network care and the Preferred Benefit level for in-network care.	Yes, for urgent and emergency care, at the Non-Network Benefits level for out-of-network care. Care provided in-network is covered at the Network Benefits level.
How does the monthly premium cost compare?	$$	$$$	$$$$

*PriorityPOS includes two benefit levels: Preferred (in-network) and Alternate (out of-network). A Primary Care Provider is required. Referrals are required for the Preferred Benefits level to apply. The Preferred Benefits level applies even if the referral is made to an out-of-network provider.
**PriorityPPO includes two benefit levels: Network (in-network) and Non-Network (out of-network). No Primary Care Provider is required.