PriorityHMO tiered copay: West MI Partners

Plan highlights

  • Primary doctor visits - Comprehensive office visits before deductible, including related non-surgical services (like X-rays, labs, etc.)
  • Specialist visits - Covered before deductible
  • Urgent care - Covered before deductible
  • Generic drugs - Copayment before deductible
  • Cash rewards - Our Cost Estimator lets you shop for high-quality care at lower-priced facilities. Best of all? When you receive care at a fair-price facility, we'll send you a Visa® reward card.
  • No referral needed - Our plans don't require a referral to see a specialist
  • Optional dental coverage - Two plans to choose from, both include annual exams and cleanings (learn more)

West MI Partners network

Our tiered network HMO plan is available to small employers within an 8.5-county* area and includes "tier 1" care providers who have privileges at Spectrum Health, Holland Hospital and Metro Health.

In a tiered network, members pay less out-of-pocket for care from hospitals and primary care providers that are high-quality and lower cost.

Emergency services outside of this plan's limited network are covered. Use our Find a Doctor online directory to find providers in the West MI Partners network.

Ideal solution if:

You're a price-sensitive employer with employees that are geographically located within The "tier 1" service area includes the northern half of Allegan*, Lake, Kent, Mason, Mecosta, Montcalm, Newaygo, Osceola and Ottawa counties.**

West Michigan Partners

*ZIP codes in Allegan where tiered network is offered: 49423, 49453, 49406, 49419, 49464, 49426,49315, 49323, 49328, 49335, 49316, 49333, 49348, 49408, 49311, 49314

Not included in tiered network: 49344, 49070, 49078, 49080, 49010, 49026, 49055, 49056, 49090, 49450, 49416. 

**The full-network PriorityExtras HMO product is only available where the tiered network PriorityExtras HMO product is not.

PriorityHMO 1000 tiered copay West MI Partners

  • Metal level

    Gold

  • Deductible

    Tier 1: $1,000 individual,
    $2,000 family
    Tier 2: $4,000 individual, $8000 family

  • Coinsurance

    Tier 1: Employee pays 20%
    Tier 2: Employee pays 40%

  • Out-of-pocket limit

    Tier 1: $4,500 individual, $9,000 family
    Tier 2: $6,500 individual, $13,000 family

  • Rx copayments

    Generic: $20
    Preferred brand: $60
    Non-preferred brand: $80
    Preferred specialty: 20%
    Non-preferred specialty: 20%

  • Primary / specialist / urgent care

    Tier 1: $15 / $30 / $75 copayment
    Tier 2: $45 / $60 / $75 copayment

  • Emergency room

    Tier 1: $150 copayment
    Tier 2: $150 copayment

  • High-tech radiology

    Tier 1: $150 copayment
    Tier 2: $300 copayment