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Priority HMO/EPO Health Insurance Plans

What's new 2008

PriorityHMO and PriorityEPO: Great coverage and lower cost

PriorityHMOSM, our Michigan health maintenance organization (HMO) plan, is our most popular group health insurance option. PriorityEPOSM is an "exclusive provider organization," a very similar health insurance plan. It is "self-funded" by your employer, so some benefits may be added or deleted by your employer. Both plans combine great medical benefits with cost savings by ensuring that you get all the health care and medical services you need, but none that are unnecessary.

HMO/EPO plan features

  • You choose a primary care doctor or other primary health care provider to be your "PCP." Your PCP coordinates all your health care.
  • You don't need a referral from your PCP to see a specialist, unless the specialist requires one.
  • No claim forms to file. We take care of the paperwork. You won't have to pay doctor bills up front and then wait for reimbursement.
  • Your plan may have a deductible, which works just like a car insurance deductible. It's the part you have to pay for health care services covered by your plan before the plan starts to pay for your care.
  • The plan pays for your preventive care before you meet your deductible. You just pay your plan's copays, and then Priority Health pays the rest of the cost of your routine physicals, immunizations, prenatal care and mammograms. The Preventive Health Care Guidelines show what's included as "preventive care."
  • You're covered for urgent and emergency care no matter where you travel around the world. Just go to an ER or Urgent Care Center.
  • You'll need to get approval up front from Priority Health before you get some services, such as surgeries.
See a comparison of the PriorityHMO to PriorityPOS and PriorityPPO plans.

When you have PriorityHSA

The way your HMO plan works changes slightly. Visit our HMO with HSA page to find out more.

Member information:

Staying healthy

Preventive care is the best way to keep yourself healthy and your costs down. Check the Priority Health Preventive Health Care Guidelines to see what shots, screenings and check-ups we recommend for our members of every age.
Go to the Preventive Health Care Guidelines.

Finding doctors, hospitals, and other health care providers

When you enroll in a PriorityHMO or PriorityEPO plan, you and each of your family members must choose a primary care doctor or other primary health care provider (a "PCP"). If you don't choose a PCP, we'll assign one to you.

Use the online Find a Doctor directory on this website to see what doctors, specialists, medical equipment suppliers, therapists, pharmacies and other health care providers are in your plan's network. You can search for health care providers by name, by location (ZIP code, city, and county), by specialty, and many other options.
Go to the Find a Doctor directory now.
  • Choose from thousands health care providers.
  • Members and their dependents can each choose different PCPs. For example, a woman might choose an OB/GYN who participates as a PCP; parents might choose a pediatrician as their child's PCP.
  • You can change PCPs at any time. The change will take effect on the first day of the following month.

Finding what drugs are covered by your plan

When you have prescription coverage, you can use the online Approved Drug List to look up what drugs are covered by your plan, which are generic and which are brand name. If you log in to your account on this website, the Approved Drug List will also show you what your copay will be for each covered drug.
Go to the Approved Drug List now.

PriorityHMO member documents

Your plan stays the same for 12 months, so if your plan began in March, use the same plan document until the following March.

PriorityEPO member documents

Your plan stays the same for 12 months, so if your plan began in March, use the same plan document until the following March.

Last modified 07/20/10