Tiered copay plans—Upper Peninsula

Plan highlights

  • $0 virtual care and telehealth services – Covered in full before deductible
  • Diabetic coverage – Certain diabetic supplies purchased through a participating DME provider are covered at 100% before deductible and preferred insulins are covered at the Tier 1b prescription drug tier
  • Chiropractic care – Covers up to 30 acute and/or maintenance care visits per contract year
  • Standard copayments for the benefits needed most – Primary care, specialist, urgent care, labs, standard radiology, and prescription drugs are covered with a copayment before deductible
  • Cash rewards – Our Cost Estimator tool lets members shop for high-quality care at lower-cost facilities. Best of all, when members receive care at a fair-price facility, we’ll send them a Visa® reward card
  • Hearing exams and discounts on high-quality hearing aids – Offered by our partner, TruHearing
  • Adult vision coverage, powered by EyeMed – $15 annual eye exam and in-network discounts on frames, standard plastic lenses, lens options, select contact lenses, laser vision correction, and non-prescription sunglasses
  • Optional dental coverage – Two Delta Dental PPO/Premier plans to choose from, both include annual exams and cleanings. Learn more
  • No referral needed – Our plans don’t require a referral to see a specialist

PPO plans

PriorityPPOSM offers employees the greatest freedom of choice by providing in-network and out-of-network options.

  • Employers reap the benefits of a low-cost health care plan, while employees can choose to see Priority Health network providers and pay less or visit non-network doctors or hospitals and pay more.
  • It lets members receive in-network benefits without having a designated primary care provider (PCP).

Tiered copay PPO plans—Upper Peninsula

  • PriorityPPO 250 100%

    Deductible:
    $250 individual, $500 family
    Coinsurance:
    Employee pays 0%
    Out-of-pocket limit: $5,000 individual, $10,000 family
    Primary / specialist / urgent care:
    $10 / $35 / $75
  • PriorityPPO 250 90%

    Deductible:
    $250 individual, $500 family
    Coinsurance:
    Employee pays 10%
    Out-of-pocket limit: $5,000 individual, $10,000 family
    Primary / specialist / urgent care:
    $10 / $35 / $75
  • PriorityPPO 500

    Deductible:
    $500 individual, $1,000 family
    Coinsurance:
    Employee pays 20%
    Out-of-pocket limit: $7,350 individual, $14,700 family
    Primary / specialist / urgent care:
    $20 / $50 / $75
  • PriorityPPO 1000

    Deductible:
    $1,000 individual, $2,000 family
    Coinsurance:
    Employee pays 20%
    Out-of-pocket limit: $7,350 individual, $14,700 family
    Primary / specialist / urgent care:
    $20 / $50 / $75
  • PriorityPPO 1500

    Deductible:
    $1,500 individual, $3,000 family
    Coinsurance:
    Employee pays 20%
    Out-of-pocket limit: $7,350 individual, $14,700 family
    Primary / specialist / urgent care:
    $20 / $50 / $75
  • PriorityPPO 2000

    Deductible:
    $2,000 individual, $4,000 family
    Coinsurance:
    Employee pays 20%
    Out-of-pocket limit: $7,350 individual, $14,700 family
    Primary / specialist / urgent care:
    $20 / $50 / $75
  • PriorityPPO 2750

    Deductible:
    $2,750 individual, $5,500 family
    Coinsurance:
    Employee pays 30%
    Out-of-pocket limit: $7,260 individual, $14,520 family
    Primary / specialist / urgent care:
    $45 / $75 / $85
  • PriorityPPO 3500

    Deductible:
    $3,500 individual, $7,000 family
    Coinsurance:
    Employee pays 30%
    Out-of-pocket limit: $7,350 individual, $14,700 family
    Primary / specialist / urgent care:
    $35 / $65 / $75
  • PriorityPPO 4500

    Deductible:
    $4,500 individual, $9,000 family
    Coinsurance:
    Employee pays 30%
    Out-of-pocket limit: $7,350 individual, $14,700 family
    Primary / specialist / urgent care:
    $35 / $65 / $75