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 pay 100% of the cost of your health care out of your pocket until you meet your deductible.
Highlights of what members get:
- Virtual care: 24/7 non-emergency care by phone or online.
- Vision coverage: Embedded vision exam and discounts, available through EyeMed.
- 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.
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.
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%. Gold plans generally have higher premiums, but lower out-of-pocket costs at time of service.
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.
Primary doctor, specialist, urgent care
24/7 non-emergency care by phone, video 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.
After deductible, waived if admitted
An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm.
Preferred generic and generic drugs
A prescription drug that has the same active-ingredient formula as a brand-name drug. Generic drugs usually cost less than brand-name drugs. The Food and Drug Administration (FDA) rates these drugs to be as safe and effective as 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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Narrow network - HMO
- HMO Silver 3200 - Off-Marketplace - Beaumont Health Network
- HMO Silver 3200 - Off-Marketplace - Bronson Healthcare Partners
- HMO Silver 3200 - Off-Marketplace - Spectrum Health Partners
- HMO Silver 3200 - Off-Marketplace - St. John Providence Network
- HMO Silver 3200 - Off-Marketplace - St. Joseph Mercy Health System Network
- HMO Silver 3200 - Beaumont Health Network
- HMO Silver 3200 - Bronson Healthcare Partners
- HMO Silver 3200 - Spectrum Health Partners
- HMO Silver 3200 - St. John Providence Network
- HMO Silver 3200 - St. Joseph Mercy Health System Network
Narrow network - HSA
- HMO HSA Bronze 6750 - Beaumont Health Network
- HMO HSA Bronze 6750 - Bronson Healthcare Partners
- HMO HSA Bronze 6750 - Spectrum Health Partners
- HMO HSA Bronze 6750 - St. John Providence Network
- HMO HSA Bronze 6750 - St. Joseph Mercy Health System Network
- HMO HSA Silver 3000 - Off-Marketplace - Beaumont Health Network
- HMO HSA Silver 3000 - Off-Marketplace - Bronson Healthcare Partners
- HMO HSA Silver 3000 - Off-Marketplace - Spectrum Health Partners
- HMO HSA Silver 3000 - Off-Marketplace - St. John Providence Network
- HMO HSA Silver 3000 - Off-Marketplace - St. Joseph Mercy Health System Network