MyPriority HMO HSA Silver 3000 – Off-Marketplace Spectrum Health Partners 

MyPriority HMO HSA Silver 3000 – Off-Marketplace (full or narrow network) plans are an affordable option for individuals who do not qualify for a federal subsidy or choose not to use it. It offers a lower monthly premium because you purchase it directly from Priority Health and avoid fees associated with plans offered on the federally run Marketplace.

This plan comes with a health savings account ( HSA ) that will help pay for medical expenses, is eligible for federal tax advantages and any unused money automatically rolls over from year to year.

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 you get:

  • Free HSA banking partner: HealthEquity® sets up and helps you manage your  HSA banking account
  • 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
  • Virtual care: 24/7 non-emergency care by phone or online. Deductible applies

Spectrum Health Partners: Narrow network option for Kent County residents

Members who choose one of these plans are required to receive care in the Spectrum Health system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc.

Network includes:

  • Spectrum Health hospitals (including those outside Kent County)
  • Spectrum Health Medical Group
  • Physicians who designate a Spectrum Health hospital as their primary hospital affiliation
  • Orthopedic Associates of Michigan (OAM) physicians (procedures must be done at a Spectrum Health facility)
  • Ancillary facilities such as Mary Free Bed, Pine Rest and Forest View
  • 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 Spectrum Health Partners network on their ID cards.
  • Care received outside of the Spectrum Health Partners network will not be covered and members will be required to cover the full cost for out-of-network care.

Network

Spectrum Health Partners

You must receive care in the Spectrum Health system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc. Emergency services are covered at the in-network level. Use our Find a Doctor online directory to see if your doctor is in the Spectrum Health Partners network.

Metal level

Silver

The metal level determines how you and your plan share the costs of care. Silver means your health plan pays 70% (on average) and you pay about 30%.

Deductible

$3,000
Individual
$6,000
Family

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

Coinsurance

70%
Plan pays
30%
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

$6,750
Individual
$13,500
Family

Your annual maximum cost. The most you’ll pay for health care services including copays and prescription drugs in one year.

Office visits

30%
Coinsurance after deductible 
 

Virtual care

Deductible applies

24/7 non-emergency care by phone, video 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

30%
Coinsurance after deductible

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

30%
Coinsurance after deductible

Preferred generics and generic drugs

30%
Coinsurance after deductible

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.