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:

Benefit Standard plan High plan Enhanced Medicare Part B benefit*
Primary care visits $25 copayment $15 copayment No charge
Specialist visits $45 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) $150 copayment** $100 copayment No charge
Ambulance services  $150 copayment** $100 copayment No charge
Prescription drugs Generic: $20 copayment
Preferred brand:
$60 copayment
Non-preferred brand:
$90 copayment
Preferred specialty:
20% coinsurance ($400 limit for 31-day supply)
Non-preferred specialty:
20% coinsurance ($400 limit for 31-day supply)
Generic: $15 copayment
Preferred brand:
$50 copayment
Non-preferred brand:
$80 copayment
Preferred specialty:
20% coinsurance ($150 limit for 31-day supply)
Non-preferred specialty:
20% coinsurance ($300 limit for 31-day supply)
Generic:
$15 for standard plan, $10 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 $6,760 single/$13,500 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.

Go to the Approved Drug List now.

Contact us

Would you like additional information about Priority Health, or are you interested in having us at your next Open Season health fair? Contact us today!

Contact us

Call: 800.446.5674

Email: customerservice@priorityhealth.com

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