MyPriority Balanced Silver Off Marketplace

MyPriority® Balanced Silver plan is a smart balance between having coverage in case of a major health care need and the reassurance of access to routine and general care for just a copay before the annual deductible.

With extra benefits and resources at low or zero cost, we'll help you balance saving money and staying healthy.

What is an Off Marketplace plan? If you don't qualify for a federal subsidy–or would rather not use one–you can save money on your monthly premium by purchasing an Off Marketplace plan directly from Priority Health.

Helping you stay healthy and engaged is our priority.

  • Prescription coverage: Low copays on Tier 1 drugs, before deductible.
  • Virtual urgent care: Before your deductible is met, virtual urgent care visits are covered in full when scheduled through the Priority Health member app.
  • On-demand mental health support: Get access to a digital solution that helps with stress, anxiety, chronic pain and more. It can be self-directed or used with coaching support, available at no cost.
  • Chronic condition management: Before your deductible is met, certain services, supplies and prescriptions used to treat common long-term health conditions are covered with cost share or in full.
  • Diabetes management: Before your deductible is met, certain supplies, treatments, prescriptions and tests are covered with cost share or in full.
  • Global emergency assistance: If you become ill or injured while traveling more than 100 miles from home, our partner Assist America® will help you get care and arrange your safe travel home.
  • Care for your hearing: Get discounts for you and your extended family for hearing exams and hearing aids through TruHearing.®

Network

HMO

An HMO provides care through a designated network of doctors, specialists and facilities that members must use in order to be covered by the plan. A primary care provider coordinates your care and you need to see an in-network doctor unless it's an emergency or you get prior approval.

Use our Find a Doctor tool to see if your doctor is in-network.

Metal level

Silver

The metal level determines how you and your plan share the costs of care. Silver means your health plan pays 70% (on average) and you pay about 30%. Silver level plans offer a good balance of premium and out-of-pocket costs. 

Deductible

$3,600
Individual
$7,200
Family

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

Coinsurance

70%
Plan pays
30%
You pay

Coinsurance is the percentage of the cost of medical services you have to pay after you've met your deductible. Some services–like preventive care and chronic condition management–are accessible with low or no coinsurance before you meet your deductible.

Out-of-pocket limit

$9,400
Individual
$18,800
Family

This is the most you'll pay for covered health care expenses in one year. This amount includes deductibles, coinsurance and copayments for covered services.

Office visits

$30 copayment
Primary care
Before deductible
$85 copayment
Specialist
Before deductible
$30 copayment
Mental health
Before deductible

Initial mental health visit is covered in full, before deductible.

Tier 1a and Tier 1b drugs

$5 copayment
Tier 1a
Before deductible
$20 copayment
Tier 1b
Before deductible

Tier 1 includes low-cost generic drugs, proven to be as safe as brand-name drugs.

Urgent care and Retail health clinics

$75 copayment
Urgent care
Before deductible
$75 copayment
Retail health clinic
Before deductible

Emergency room

$250 copay + 30% coinsurance
Emergency room
After deductible

Emergency room copayment is waived if admitted.

Virtual care

$10 copayment
Virtual primary care
Before deductible
Covered in full
Virtual urgent care
Before deductible

Virtual primary care is offered through Corewell Health's Virtual Primary Care Practice in West Michigan when you select a Corewell Health Virtual Primary Care Practice provider as your designated PCP.

See a provider through Virtual Urgent Care provided by Corewell Health. This care is accessed through your Priority Health member account and is best for treating minor illnesses and injuries like ear infections, fevers, coughs, minor burns or bites.

Preventive care

Covered in full
Before deductible

Preventive services help you avoid potential health problems or find them early when they are most treatable before you feel sick or have symptoms. See our Preventive Health Care Guidelines for a list of covered preventive services.

Maternity

Covered in full
Routine prenatal and postnatal care
Before deductible
Delivery and nursery care are covered with 30% coinsurance, after deductible.

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

30% coinsurance
After deductible

The features and benefits shown on this page are intended to give you an overview of what this plan covers. For more details, please refer to the Summary of Benefits and Coverage.