MyPriority Gold 1100

Our MyPriority® 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:

  • Limited virtual care: 24/7 access to a doctor with a Spectrum Health On-Demand Video Visit
  • Prescription drugs: 20% coinsurance for Tier 1a and Tier 1b drugs, after deductible
  • Chronic condition management: Services, supplies and treatments for some of the most common chronic conditions covered in full or with cost-share, before deductible
  • 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
  • Global emergency assistance: If you 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®

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-Facilitated Marketplace (FFM).

Network

HMO

An HMO is a type of health plan that provides care through a designated network of doctors, specialists and facilities that members must use in order to be covered by the plan. 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 75% on average and you pay about 25%.

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.

Office visits

20% coinsurance
Primary care, after deductible 
20% coinsurance

Specialist, after deductible
20% coinsurance
Mental health, after deductible

Limited virtual care

Covered in full

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.

Retail health, urgent care and emergency services

20% coinsurance
Retail health clinic, after deductible   
20% coinsurance

Urgent care, after deductible
20% coinsurance
Emergency room, after deductible

An illness, injury, symptom or condition that needs immediate care to avoid the worsening of the condition.

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

20% coinsurance
After deductible

Tier 1a and Tier 1b drugs

20% coinsurance
After deductible
The least expensive prescription drugs available to you. This tier includes low-cost generic drugs—proven to be as safe as brand-name drugs—and, on some formularies, select 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.