MyPriority Silver 2500 - St. Joseph Mercy Health System Network

MyPriority® Silver 2500 (full or narrow network) plans are a smart option for individuals and families that don’t anticipate needing major health care services and want the reassurance of being covered for general care. This plan is especially great for individuals who travel and want peace of mind knowing they’re covered wherever they go.

Highlights of what members get:

  • Out-of-state coverage: Four out-of-state Cigna network office visits included
  • Limited virtual care: 24/7 access to a doctor with a Spectrum Health On-Demand Video Visit
  • Prescription drugs: $5 copayment for Tier 1a and $20 copayment for Tier 1b drugs, before deductible
  • Primary doctor visits: $30 primary care doctor visits, before deductible
  • Urgent care: $75 urgent care visits, before deductible
  • Chronic condition management: Services, supplies and treatments for some of the most common chronic conditions covered in full or with cost-share, before deductible
  • 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
  • Global emergency assistance: If you 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®

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:

Hospitals

  • 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

Physician network

Physicians who are affiliated with St. Joseph Mercy groups as listed below:

  • IHA
  • 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

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 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-Facilitated Marketplace (FFM).

Network

St. Joseph Mercy Health System Network

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.

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%. Silver level plans offer a good balance of premium and out-of-pocket costs. 

Deductible

$2,500
Individual
$5,000
Family

The amount you pay for covered health care services before Priority Health begins to pay.

Coinsurance

70%
Plan pays
30%
You pay

Coinsurance is the percentage of the cost of medical services you have to pay after you've met your deductible. Some services–like preventive care and chronic condition management–are accessible with low or no coinsurance before you meet your deductible.

Out-of-pocket limit

$8,700
Individual 
$17,400
Family

This is the most you'll pay for covered health care expenses in one year. This amount includes deductibles, coinsurance and copayments for covered services.

Office visits

$30 copayment

Primary doctor, before deductible
$90 copayment

Specialist, before deductible  
$30 copayment
Mental health, before deductible (initial visit covered in full)

Limited virtual care

Covered in full

24/7 access to a provider with a Spectrum Health On-Demand virtual urgent care.

Preventive care

Covered in full

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

$75 copayment
Retail health clinic, office visits (evaluation only), before deductible
$75 copayment
Urgent care, office visits (evaluation only), before deductible 
$250 copayment
Emergency room (waived if admitted); 30% coinsurance, after deductible

When you seek treatment for an illness, injury, symptom or condition that needs immediate care.

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

30% coinsurance
After deductible

Tier 1a and Tier 1b drugs

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

Tier 1 includes low-cost generic drugs, proven to be as safe 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.