MyPriority HMO Gold Copay+ - Beaumont Health Network

Our MyPriority® HMO Gold Copay+ plan 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 you get:

  • $0 deductible
  • Virtual care: 24/7 non-emergency care by mobile device or online (i.e. Spectrum Health App)
  • Prescription drugs: $5 copay for Tier 1a drugs
  • Chronic condition management: Services, supplies and treatments for some of the most common chronic conditions, with cost-share, before deductible
  • Primary doctor visits: $20 primary care doctor visits
  • Urgent care: $75 urgent care visits
  • 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

Beaumont Health Network: Narrow network option for residents of Wayne, Oakland and Macomb counties

Members who choose a Beaumont Health Network plan are required to receive care in the Beaumont Health system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc.

The network includes:

Hospitals

  • Beaumont Hospital, Dearborn (formerly Oakwood Hospital, Dearborn)
  • Beaumont Hospital, Farmington Hills (formerly Botsford Hospital)
  • Beaumont Hospital, Grosse Pointe
  • Beaumont Hospital, Royal Oak
  • Beaumont Hospital, Taylor (formerly Oakwood Hospital, Taylor)
  • Beaumont Hospital, Trenton (formerly Oakwood Hospital, Southshore)
  • Beaumont Hospital, Troy
  • Beaumont Hospital, Wayne (formerly Oakwood Hospital, Wayne)

Physician network

  • Physicians employed by Beaumont Health
  • Any individual community physicians with admitting privileges at Beaumont Health that are listed as in-network in the Priority Health Beaumont Network Find a Doctor directory

All in-network pharmacies

Details:

  • A narrow network allows members to enjoy a lower monthly premium while getting access to quality care.
  • Members who enroll in this plan will see the Beaumont Health Network on their ID cards.
  • Care received outside of the Beaumont Health network will not be covered, and members will be required to cover the full cost for out-of-network care.

Network

Beaumont Health Network

You must receive care in the Beaumont Health Network system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc. Care received outside of the Beaumont Health 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 Beaumont Health 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%.

Deductible

$0
Individual
$0
Family

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

Coinsurance

100%
Plan pays
0%
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

$8,550
Individual
$17,100
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 

Office visits

$20 copayment
Primary doctor
$45 copayment
Specialist
$75 copayment
Urgent care

Virtual care

$0 copayment

24/7 non-emergency care by mobile device 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

$250
Waived if admitted
0%
Coinsurance

An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm.

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

$45 copayment

Tier 1a and Tier 1b drugs

$5 copayment
Tier 1a 
 
$20 copayment
Tier 1b

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.