MyPriority HSA Silver 3000 - Off Marketplace - Ascension St. John Providence Network
MyPriority® 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 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 members get:
- Free HSA banking partner: HealthEquity® sets up and helps you manage your banking account
- Limited virtual care: 24/7 access to a doctor with a Spectrum Health On-Demand Video Visit
- Chronic condition management: Services, supplies, and treatments for some of the most common chronic conditions, 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®
Ascension St. John Providence Network
A narrow network offered to individuals who live in Wayne, Oakland and Macomb counties
Members who choose an Ascension St. John Providence Network plan are required to receive care in the Ascension St. John Providence system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc.
This network includes:
Hospitals: Ascension Macomb-Oakland Hospital – Madison Heights Campus, Ascension Macomb-Oakland Hospital – Warren Campus, Ascension River District Hospital, Ascension Providence Rochester Hospital, Ascension Providence Hospital – Novi Campus, Ascension Providence Hospital – Southfield Campus, Ascension St. John Hospital
Physicians (primary care and specialist) network: Physicians who are affiliated with the Ascension St. John Providence groups listed below:
- Ascension St. John and St. John North Shore
- Ascension St. John River District
- Ascension St. John Oakland
- Ascension St. John Macomb
- Ascension St. John Cornerstone
- Ascension Providence Hospital
All in-network pharmacies
- A narrow network allows members to enjoy a lower monthly premium while getting access to quality care
- No referral needed to see an in-network specialist
- Members who enroll in this plan will see the Ascension St. John Providence network on their ID cards
- Care received outside of the Ascension St. John Providence network will not be covered, and members will be required to cover the full cost for out-of-network care
Members must receive care in the Ascension St. John Providence Network system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc. Care received outside of the Ascension St. John Providence 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 Ascension St. John Providence Network.
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.
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, after deductible
Specialist, after deductible
Mental health, after deductible (initial visit covered in full, after deductible)
Limited virtual care
24/7 access to a doctor with a Spectrum Health On-Demand Video Visit.
Retail health, urgent care and emergency services
Retail health clinic, after deductible
Urgent care, after deductible
Emergency room, after deductible
An illness, injury, symptom or condition that needs immediate care to avoid the worsening of the condition.
Diagnostic tests, X-rays, lab services and radiology services
Tier 1a and Tier 1b drugs
Tier 1a, after deductible
Tier 1b, after deductible
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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