MyPriority HSA Silver 3000 - Off Marketplace - Spectrum Health Partners

MyPriority® HSA Silver 3000 - Off-Marketplace 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.

Your health is our top priority

Earning 4 out of 5 stars* on healthcare.gov, Priority Health gives you more for your money and does more to improve your health.

Highlights of what members get:

  • Free HSA banking partner: HealthEquity® sets up and helps you manage your banking account
  • On-demand mental health support: myStrength, included in our plans, is a mental health and wellness online tool that helps you live your best life.
  • Chronic condition management: Access to a variety of medications, supplies and services to help keep your chronic conditions under control–covered in full or with a low cost share, before deductible.
  • Diabetes management: Our plans provide coverage for diabetes management services, supplies and treatments for no cost, before deductible when furnished by a participating durable medical equipment (DME) provider. Diabetes prescriptions and testing procedures are covered before deductible, with cost share.
  • Global emergency assistance: If you or your dependents 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®

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 with the exception of Spectrum Health Lakeland)
  • Spectrum Health Medical Group
  • Physicians who denote a Spectrum Health hospital in Grand Rapids as their primary hospital affiliation
  • Orthopedic Associates of Michigan (OAM) physicians (procedures must be done at a Spectrum Health facility)
  • Ancillary facilities such as Pine Rest Christian Mental Health Services and Forest View Hospital
  • 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 Partners network of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc. Care received outside of the Spectrum Health Partners 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 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%. Silver level plans offer a good balance of premium and out-of-pocket costs. 

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 met your deductible, coinsurance is the percentage of the cost for medical services you have to pay. Preventive health services are covered at 100%.

Out-of-pocket limit

$7,050
Individual
$14,100
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
Primary doctor, after deductible
30% coinsurance
Specialist, after deductible
  
30% coinsurance
Mental health, after deductible

Limited virtual care

Covered in full, after deductible

24/7 access to a doctor with a Spectrum Health On-Demand Video Visit.

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

30% coinsurance
Retail health clinic, after deductible
30% coinsurance
Urgent care, after deductible
 
30% coinsurance
Emergency room, 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

30% coinsurance
Tier 1a, after deductible
30% coinsurance
Tier 1b, after deductible

Tier 1 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.