What your HMO plan covers
Compare the standard vs. the high option cost-sharing using the at-a-glance chart below. Both plans cover the same medical care.
Download detailed plan information:
- HMO Standard plan summary of benefits and coverage (547KB PDF)
- HMO High plan summary of benefits and coverage (545KB PDF)
- 2016 Priority Health plan brochure for Federal employees (1.4MB PDF)
|Benefit||Standard plan||High plan||Enhanced Medicare Part B benefit*|
|Primary care visits||$15 copayment||$15 copayment||No charge|
|Specialist visits||$30 copayment||$25 copayment||No charge|
|Urgent care facility||$75 copayment||$25 copayment||No charge|
|Allergy testing, serum and injections||Covered in full||Covered in full||No enhanced benefit|
|Outpatient surgery professional services||20% coinsurance**||0% coinsurance||No charge|
|Outpatient facility services||20% coinsurance**||0% coinsurance||No charge|
|Hospice care (in the home)||Covered in full||Covered in full||No enhanced benefit|
|Home health care||Covered in full||Covered in full||No enhanced benefit|
|Inpatient hospital & acute care services (PA non-emergency only)||20% coinsurance**||0% coinsurance||No charge|
|Emergency room (copay waived if admitted)||$100 copayment**||$100 copayment||No charge|
|Ambulance services||$100 copayment**||$100 copayment||No charge|
Generic: $10 copayment
Preferred brand: $45 copayment
Non-preferred brand: $90 copayment
Preferred specialty: 20% coinsurance ($150 limit for 31-day supply)
Non-preferred specialty: 20% coinsurance ($300 limit for 31-day supply)
Generic: $8 copayment
Preferred brand: $40 copayment
Non-preferred brand: $60 copayment
Preferred specialty: $80 copayment
Non-preferred specialty: $80 copayment
|Generic: $10 for standard plan, $5 for high plan|
|Deductible||$350 single/$700 family (medical-only deductible)||$0 single/$0 family (medical only deductible)||No deductible|
|Coinsurance maximum||No||No||No enhanced benefit|
|Out-of-pocket limit||$6,600 single/$13,200 family||$6,600 single/$13,200 family||No enhanced benefit|
|Prior deductible carryover||Yes||N/A||No enhanced benefit|
*If you are paying for Medicare Part B (hospitalization), you can pay less for many common medical expenses. You'll need to send in a form to let us know you're receiving Medicare Part B benefits. Call the number on the back of your Priority Health membership card if you're already a Priority Health FEHB plan member.
**After you meet your deductible
See what drugs are covered
Use our Approved Drug List online tool to search by drug name, see what drugs your plan covers and check what your copay will be.
Questions about your health insurance? We’re here to help. Call the number on the back of your membership card or the number below and a Customer Service Representative can help you.
- Monday - Thursday, 7:30 a.m. - 7:00 p.m.
- Friday, 9:00 a.m. - 5:00 p.m.
- Saturday, 8:30 a.m. - 12:00 p.m. (Eastern Time)