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

HMO

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

Gold

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%. Gold plans generally have higher premiums, but lower out-of-pocket costs at time of service.

Deductible

$1,100
Individual
$2,200
Family

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

Coinsurance

80%
Plan pays
20%
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

$8,150
Individual
$16,300
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 then coinsurance
Primary doctor, specialist, urgent care

Virtual care

$0 copayment
Before deductible

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

Coinsurance, after deductible

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

Coinsurance, after deductible

Preferred generic and generic drugs

Coinsurance, after deductible

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.