MyPriority Standard Bronze 7500 - Trinity Health East Network

MyPriority® Standard Bronze 7500 is a standardized plan, offered by qualified health plans (QHPs) on the federal Marketplace. Standard plans have uniform plan designs with the same cost-sharing parameters from issuer to issuer, making plan choice and comparison simpler for enrollees. These standard plans allow consumers to more easily find the right form of quality, affordable health coverage for their circumstances.

Your health is our top priority

Earning 4 out of 5 stars* on healthcare.gov, Priority Health gives you more for your money and does more to improve your health.

Highlights of what members get:

  • On-demand mental health support: myStrength, included with no added cost, is a mental health and wellness online tool that helps you live your best life.
  • Chronic condition management: Access to a variety of medications, supplies and services to help keep your chronic conditions under control—covered in full or with a low cost share, before deductible.
  • Diabetes management: Our plans provide coverage for diabetes management services, supplies and treatments for no cost, before deductible when furnished by a participating durable medical equipment (DME) provider. Diabetes prescriptions and testing procedures are covered before deductible, with cost share.
  • Global emergency assistance: If you or your dependents become ill or injured while traveling more than 100 miles from home, our partner Assist America® can help you get care and even arrange your safe travel home.
  • Hearing exams and hearing aids: Discounts for you and your extended family with TruHearing®

Trinity Health East Network

A narrow network offered to individuals who live in Wayne, Oakland, Macomb, Washtenaw, Livingston counties and a portion of Jackson County*

Members who choose a Trinity Health East Network plan are required to receive care in the Trinity Health East System network of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc.

This network includes:

Hospitals: Trinity Health Chelsea Hospital, Trinity Health Ann Arbor Hospital, Trinity Health Livingston Hospital, Trinity Health Oakland Hospital, Trinity Health Livonia Hospital

Physicians (primary care and specialist) network: Physicians who are affiliated with the Trinity Health East groups as listed below:

  • IHA
  • Huron Valley Physician Association
  • Oakland Physician Network Services with Trinity Health Oakland designated as the primary hospital
  • Livingston Physician Organization
  • Trinity Health Livonia Physician Practices

All in-network pharmacies

Details:

  • A narrow network allows members to enjoy a lower monthly premium while getting access to quality care
  • No referral needed to see an in-network specialist
  • Members who enroll in this plan will see the Trinity Health East network on their ID cards
  • Care received outside of the Trinity Health East Network will not be covered, and members will be required to cover the full cost for out-of-network care

*ZIP codes in Jackson County where the Trinity Health East narrow network is offered: 49201, 49202, 49203, 49204, 49230, 49240, 49254, 49259, 49261, 49263, 49272, 49277, 49285

Your out-of-pocket costs may vary based on your subsidy level from the Federally-Facilitated Marketplace (FFM).

Network

Trinity Health East Network

In order for your health care costs to be covered, you must receive care from doctors and hospitals within the Trinity Health East Network or their affiliated facilities. If you receive care from an out-of-network provider, you will be responsible for paying the full cost. Emergency services are covered at the in-network level.

Use our Find a Doctor online directory to see if your doctor is in the Trinity Health East Network.

Metal level

Bronze

The metal level determines how you and your plan share the costs of care. Bronze means generally lower premium costs but higher out-of-pocket costs at time of service.

Deductible

$7,500
Individual
$15,000
Family

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

Coinsurance

50%
Plan pays
50%
You pay

After you’ve met your deductible, coinsurance is the percentage of the cost for medical services you have to pay. Preventive health services are covered at 100%.

Out-of-pocket limit

$9,000
Individual
$18,000
Family

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

Office visits

$50 copayment
Primary care
Before deductible
$100 copayment
Specialist
Before deductible
$50 copayment
Mental health
Before deductible

Tier 1a and Tier 1b drugs

$25 copayment
Tier 1a
Before deductible
$25 copayment
Tier 1b
Before deductible

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

Retail health, urgent care and emergency services

$75 copayment
Retail health clinic, office visits (evaluation only), before deductible
$75 copayment
Urgent care, office visits (evaluation only), before deductible
50% coinsurance
Emergency services, after deductible

When you seek treatment for an illness, injury, symptom or condition that needs immediate care.

Limited virtual care

Covered in full
Before deductible

24/7 access to a provider with a Spectrum Health On-Demand virtual urgent care.

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

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

50% coinsurance
After deductible

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.