MyPriority HMO RxPlus Gold 200

Our MyPriority® RxPlus plans are designed for people who want the best coverage for their money or may be transitioning from employer-provided insurance to buying direct. You get immediate, affordable access to office visits, including specialists and generic drugs, before you meet your annual deductible.

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Highlights of what you get

  • $20 office visits – Any combination of up to four specialist, family doctor or urgent care visits before deductible, including related non-surgical services (like X-rays, labs, etc.)
  • $5 generic drugs – You get generic prescriptions for a $5 or $10 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 coverageTwo plans to choose from, both include annual exams and cleanings.

More about MyPriority HMO RxPlus Gold 200

Network

HMO

With an HMO, you choose a primary doctor that coordinates your care. You need to see an in-network doctor unless it's an emergency or you get prior approval. Use our Find a Doctor online directory to see if your doctor is in-network.

Metal level

Gold

The metal level determines how you and your plan share the costs of care. Gold means your plan pays 80% on average and you pay about 20%.

Deductible

$200
Individual
$400
Family

The amount you pay for in-network covered health care services before Priority Health begins to pay.

Coinsurance

80%
Plan pays
20%
You pay

This is the amount you pay in-network, after deductible. Preventive health services are covered at 100%.

Out-of-pocket limit

$6,000
Individual
$12,000
Family

The most you pay during a policy period (usually a year) before Priority Health begins to pay 100% of the allowed amount. This includes your copayments, deductibles and coinsurance payments. This limit does not include your monthly premium.

Office visits

$20 copayment
Primary doctor, specialist, urgent care

$20 copayment first 4 visits a year including onsite labs and imaging. Deductible applies after first four any office visits, then coinsurance.

Free preventive care

$0 copayment

Routine care helps keep you and your family healthy. That's why we cover preventive care like well-child visits, flu shots and annual exams at no cost. See our Preventive Health Care Guidelines for a list of covered preventive services.

Emergency services

$250
Waived if admitted
20%
Coinsurance

Diagnostic tests, X-rays, lab services and radiology services

20% coinsurance

If the service provided is done during an office visit, 100% is covered. The deductible applies after the first four of any office visits.

Virtual visits

20% coinsurance
After deductible

Generic drugs

$5 or $10 copayment
Before deductible