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’ll pay 100% of the cost for your health care out-of-pocket until the deductible is met.
Highlights of what members get:
- Virtual care: 24/7 non-emergency care by mobile device or online (i.e. Spectrum Health App)
- 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
- Chronic condition management: Services, supplies and treatments for some of the most common chronic conditions, with cost-share, before deductible
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.
Your out-of-pocket costs may vary based on your subsidy level from the Federally-Funded Marketplace (FFM).
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.
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%.
This is the amount you pay for in-network covered health care services before Priority Health begins to 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%.
Your annual maximum cost. The most you'll pay for health care services including copays and prescription drugs in one year.
Coinsurance after 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.
Diagnostic tests, X-rays, lab services and radiology services
Tier 1a and Tier 1b 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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