MyPriority Enhanced Gold
Southeast Michigan Network

You won't have to worry about meeting an annual deductible with a MyPriority® Enhanced Gold plan, in exchange for a higher monthly premium. This simplifies managing your health care expenses for any anticipated needs–and unexpected ones, too.

You get coverage that supports your physical, mental and financial health:

  • $0 deductible
  • $5 copay for tier 1a prescriptions
  • $20 copay for primary care visits
  • $45 copay for specialist visits
  • $0 limited virtual urgent care visits through Corewell Health Virtual Urgent Care, before deductible
  • On-demand mental health support through Teladoc Health Mental Health
  • Access to a large network of high-quality primary care providers across Michigan
  • Award-winning customer service

Southeast Michigan Network

This narrow network plan is offered to individuals who live in Macomb, Oakland, and Wayne counties.

To ensure coverage of your health care costs, you must receive care from doctors and hospitals within the Southeast Michigan 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.

Hospital networks

Corewell Health East hospitals

  • Corewell Health Dearborn Hospital
  • Corewell Health Farmington Hills Hospital
  • Corewell Health Beaumont Grosse Pointe Hospital
  • Corewell Health Taylor Hospital
  • Corewell Health Trenton Hospital
  • Corewell Health Beaumont Troy Hospital
  • Corewell Health Wayne Hospital
  • Corewell Health William Beaumont University Hospital

Trinity Health East hospitals

  • Trinity Health Ann Arbor Hospital
  • Trinity Health Chelsea Hospital
  • Trinity Health Livingston Hospital
  • Trinity Health Livonia Hospital
  • Trinity Health Oakland Hospital

Physician networks (primary care and specialist)

Corewell Health East hospitals

  • Physicians employed by Corewell Health in Southeast Michigan
  • Any individual community physician with admitting privileges at Corewell Health who is in-network and listed in the Priority Health Southeast Michigan Network Find a Doctor directory.

Trinity Health East hospitals

  • Any individual community physician with admitting privileges at Trinity Health who is in-network and listed in the Priority Health Trinity Health East Network Find a Doctor directory.

All in-network pharmacies

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

Network

Southeast Michigan Network

In order for your health care costs to be covered, you must receive care from doctors and hospitals within the Southeast Michigan 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 online Find a Doctor directory to check if your doctor is in-network. Change the search parameters from All plans to Southeast Michigan Network.

Metal level

Gold

The metal level determines how you and your plan share the costs of care. Gold generally means higher monthly premiums but lower out-of-pocket costs when you receive care.

Deductible

$0
Individual
$0
Family

The deductible 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

Coinsurance is the percentage of the cost of medical services you have to pay after you've met your deductible.

Out-of-pocket limit

$9,200
Individual
$18,400
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

$20 copayment
Primary care
$45 copayment
Specialist
$20 copayment
Mental health

Tier 1a and Tier 1b drugs

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

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

Urgent care and Retail health clinic

$75 copayment
Urgent care
$75 copayment
Retail health clinic

Emergency room

$250 copayment
Emergency room

Emergency room copayment is waived if admitted.

Virtual urgent care

Covered in full
Virtual urgent care

Virtual urgent care is offered through Corewell Health Virtual Urgent Care. 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.

Rehabilitation services

$45 Copayment
Chiropractic manipulation
$45 Copayment
Outpatient physical/occupational therapy

Chiropractic manipulation benefits cover 30 visits per year, including maintenance visits.

Physical therapy and occupational therapy have a combined limit of 30 visits per year.

Preventive care

Covered in full

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

Delivery and nursery care are covered with a $1,000 copayment per day (maximum 5 copayments.)

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

$45 copayment

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.