MyPriority HMO Gold Copay+ - St. Joseph Mercy Health System 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
St. Joseph Mercy Health System Network: Narrow network option for residents of Wayne, Oakland, Macomb, Washtenaw and Livingston counties
Members who choose a St. Joseph Mercy Health System Network plan are required to receive care in the St. Joseph Mercy Health System network of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc.
The network includes:
- St. Joseph Mercy Chelsea Hospital
- St. Joseph Mercy Hospital
- St. Joseph Mercy Livingston Hospital
- St. Joseph Mercy Oakland Hospital
- St. Mary Mercy Livonia Hospital
- Affiliated partners
Physicians who are affiliated with St. Joseph Mercy groups as listed below:
- Huron Valley Physician Association
- Oakland Physician Network Services – with St. Joseph Mercy Oakland designated as the primary hospital
- Livingston Physician Organization
- St. Mary Mercy Physician Practices
All in-network pharmacies
- 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 St. Joseph Mercy Health System network on their ID cards.
- Care received outside of the St. Joseph Mercy Health System 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-Funded Marketplace (FFM).
Members must receive care in the St. Joseph Mercy Health System Network system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc. Care received outside of the St. Joseph Mercy Health System 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 St. Joseph Mercy Health System 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.
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.
Waived if admitted
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
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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