MyPriority HMO HSA Bronze 6900 - Spectrum Health Partners

MyPriority® HMO HSA Bronze 6900 (full or narrow network) plans are an affordable choice if you're generally healthy and savings-minded. This plan gives you the peace of mind knowing you're protected if something catastrophic happens. Your  HSA  will help pay for medical expenses, is eligible for federal tax advantages and any unused money automatically rolls over from year to year.

Keep in mind you pay 100% of the cost of your health care out of your pocket until you meet your deductible.

Highlights of what you get:

  • Amazon HSA store: Access to our online Priority Health storefront where you can use your  HSA  to purchase thousands of eligible items.
  • Vision coverage: Embedded vision exam and discounts, available through EyeMed.
  • Free HSA banking partner: HealthEquity® sets up and helps you manage your  HSA  banking account.
  • Cost Estimator: Access to our tool to see prices for hundreds of services and procedures.
  • Active&Fit Direct™: Discounted prices for gym memberships and more!
  • Virtual care: 24/7 non-emergency care by phone or online. Deductible applies.

Spectrum Health Partners: Narrow network option for Kent County residents

Members who choose one of these plans are required to receive care in the Spectrum Health system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc.

Network includes:

  • Spectrum Health hospitals (including those outside Kent County with the exception of Spectrum Health Lakeland)
  • Spectrum Health Medical Group
  • Physicians who denote a Spectrum Health hospital in Grand Rapids as their primary hospital affiliation
  • Orthopedic Associates of Michigan (OAM) physicians (procedures must be done at a Spectrum Health facility)
  • Ancillary facilities such as Pine Rest Christian Mental Health Services and Forest View Hospital
  • All in-network pharmacies

Details:

  • A narrow network allows members to enjoy a lower monthly premium while getting access to quality care.
  • Members who enroll in this plan will see the Spectrum Health Partners network on their ID cards.
  • Care received outside of the Spectrum Health Partners network will not be covered and members will be required to cover the full cost for out-of-network care.

Network

Spectrum Health Partners

You must receive care in the Spectrum Health system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc. Emergency services are covered at the in-network level. Use our Find a Doctor online directory to see if your doctor is in the Spectrum Health Partners network.

Metal level

Bronze

The metal level determines how you and your plan share the costs of care. Bronze means your plan pays 60% on average and you pay about 40%. Bronze plans offer generally
lower premium costs, but higher out-of-pocket costs at time of service.

Deductible

$6,900
Individual
$13,800
Family

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

Coinsurance

100%
Plan pays
0%
You pay

After you've paid your deductible, coinsurance is your portion of the cost for medical services listed as benefits in your insurance plan or prescriptions listed in the approved drug list. For example, if your plan's fee for an office visit is $100 and you've met your deductible, your coinsurance payment of 20% would be $20. Priority Health would pay the rest of the fee, 80%. Preventive health services are covered at 100%.

Out-of-pocket limit

$6,900
Individual
$13,800
Family

Your annual maximum cost. The most you'll pay for health care services including copays and prescription drugs in one year.

Vision exam

$0 copayment
Before deductible

Office visits

Deductible applies
Primary doctor, specialist, urgent care

Virtual care

Deductible applies

24/7 non-emergency care by phone, video or online.

Free preventive care

$0 copayment

Preventive care includes specific health care services that help you avoid potential health problems or find them early when they are most treatable, before you feel sick or have symptoms. Examples of preventive care include flu shots, physical exams, lab tests and some prescriptions. See our Preventive Health Care Guidelines for a list of covered preventive services.

Emergency services

Deductible applies

An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm.

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

Deductible applies

Preferred generics and generic drugs

$0 copayment
After deductible is met

A prescription drug that has the same active-ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs. The Food and Drug Administration (FDA) rates these drugs to be as safe and effective as brand-name drugs.

The features and benefits explained in this section are intended to give you an overview of your coverage and do not include or explain every detail of what is and is not covered. Please refer to the Summary of Benefits and Coverage.