MyPriority Gold Copay+ - Ascension St. John Providence Network
Our MyPriority® Gold Copay+ plan (narrow networks only) is designed for individuals and families who anticipate needing health care services throughout the year. With no deductible, you share the costs with the health plan.
Highlights of what members get:
- On-demand mental health support: myStrength is a free mental health and wellness online tool that helps you live your best life.
- Chronic condition management: Access to a variety of medications, supplies and services to help keep your chronic conditions under control—covered in full or with a low cost share, before deductible.
- Diabetes management: Our plans provide coverage for diabetes management services, supplies and treatments for no cost, before deductible when furnished by a participating durable medical equipment (DME) provider. Diabetes prescriptions and testing procedures are covered before deductible, with cost share.
- Global emergency assistance: If you or your dependents 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®
Ascension St. John Providence Network
A narrow network offered to individuals who live in Wayne, Oakland and Macomb counties
Members who choose an Ascension St. John Providence Network plan are required to receive care in the Ascension St. John Providence system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc.
This network includes:
Hospitals: Ascension Macomb-Oakland Hospital – Madison Heights Campus, Ascension Macomb-Oakland Hospital – Warren Campus, Ascension River District Hospital, Ascension Providence Rochester Hospital, Ascension Providence Hospital – Novi Campus, Ascension Providence Hospital – Southfield Campus, Ascension St. John Hospital
Physicians (primary care and specialist) network: Physicians who are affiliated with the Ascension St. John Providence groups listed below:
- Ascension St. John and St. John North Shore
- Ascension St. John River District
- Ascension St. John Oakland
- Ascension St. John Macomb
- Ascension St. John Cornerstone
- Ascension Providence Hospital
All in-network pharmacies
- A narrow network allows members to enjoy a lower monthly premium while getting access to quality care
- No referral needed to see an in-network specialist
- Members who enroll in this plan will see the Ascension St. John Providence network on their ID cards
- Care received outside of the Ascension St. John Providence network will not be covered, and members will be required to cover the full cost for out-of-network care
Your out-of-pocket costs may vary based on your subsidy level from the Federally-Facilitated Marketplace (FFM).
Members must receive care in the Ascension St. John Providence Network system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc. Care received outside of the Ascension St. John Providence Network will not be covered and members will be required to cover the full cost of out-of-network care.
Emergency services are covered at the in-network level. Use our Find a Doctor online directory to see if your doctor is in the Ascension St. John Providence 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.
Limited virtual care
24/7 access to a doctor with a Spectrum Health On-Demand Video Visit.
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.
Retail health, urgent care and emergency services
Retail health clinic
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
Tier 1a and Tier 1b drugs
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.
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