MyPriority HMO Silver 3400 - Off-Marketplace - St. John Providence Network

MyPriority® HMO Silver 3400 - Off-Marketplace (full or narrow network) plans are an affordable option for individuals who do not qualify for a federal subsidy, or chose 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.

Highlights of what you get:

  • Virtual care: 24/7 non-emergency care by mobile device or online (i.e. Spectrum Health App)
  • Prescription drugs: Copay for Tier 1a and Tier 1b drugs before deductible
  • Primary doctor visits: $30 primary care doctor visits, before deductible
  • Urgent Care: $75 urgent care visits, 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

St. John Providence Network: Narrow network option for residents of Wayne, Oakland and Macomb counties

Members who choose a St. John Providence Network plan are required to receive care in the St. John Providence system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc.

The network includes:

Hospitals

  • Ascension St. John Hospital
  • St. John Macomb-Oakland Hospital (Macomb Center)
  • St. John Macomb-Oakland Hospital (Oakland Center)
  • Ascension Providence Park Hospital (Southfield Campus)
  • Crittenton Hospital Medical Center
  • St. John River District Hospital
  • Ascension Providence Park Hospital (Novi Campus)
  • Affiliated partners

Physician network

Physicians who are affiliated with Ascension-St. John Providence groups listed below:

  • St. John and St. John North Shore
  • St. John River District
  • St. John Oakland
  • St. John Macomb
  • St. John Cornerstone
  • Providence 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 St. John Providence network on their ID cards.
  • Care received outside of the St. John Providence network will not be covered, and members will be required to cover the full cost for out-of-network care.

Network

St. John Providence Network

Members must receive care in the St. John Providence Network system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc. Care received outside of the 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 St. John Providence 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

$3,400
Individual
$6,800
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

$8,550
Individual
$17,100
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 copayment
Primary doctor, before deductible 
$45 copayment
Specialist, after
deductible
$75 copayment
Urgent care, before deductible

Virtual care

Covered in full
24/7 non-emergency care by mobile device 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

$250 copayment
After deductible, waived if admitted
30%
Coinsurance

An illness, injury, symptom or condition so serious that a reasonable person would seek care right away to avoid severe harm.

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

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.