MyPriority HMO Gold 1100
Our MyPriority® HMO Gold 1100 plan is designed for individuals and families who anticipate needing health care services throughout the year. Once the deductible is met, you share the costs with the health plan.
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 members get:
- Virtual care: 24/7 non-emergency care by phone or online.
- Vision coverage: Embedded vision exam and discounts, available through EyeMed.
- 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.
This plan comes with our HMO network of doctors; however, there are some facilities that are not included. Please check our Find A Doctor tool to make sure your doctor is in network.
Network
With an HMO, you choose a primary doctor that coordinates your care. You need to see an in-network doctor unless it's an emergency or you get prior approval. Use our Find a Doctor online directory to see if your doctor is in-network.
Metal level
The metal level determines how you and your plan share the costs of care. Gold means your plan pays 80% on average and you pay about 20%.
Deductible
Individual
Family
This is the amount you pay for in-network covered health care services before Priority Health begins to pay.
Coinsurance
Plan pays
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
Individual
Family
Your annual maximum cost. The most you'll pay for health care services including copays and prescription drugs in one year.
Vision exam
Before deductible
Office visits
Primary doctor, specialist, urgent care
Virtual care
Before deductible
24/7 non-emergency care by mobile device or online.
Free preventive care
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
Diagnostic tests, X-rays, lab services and radiology services
Preferred generic and generic drugs
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.
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