MyPriority Silver 3500

MyPriority® Silver 3500 (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 can be purchased on the federal Marketplace or directly from Priority Health.

Highlights of what members get:

  • Limited virtual care services: 24/7 access to a doctor with a Spectrum Health On-Demand video visit
  • Prescription drugs: $5 copay for Tier 1a and $20 copay for Tier 1b, 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
  • Chronic condition management: Services, supplies and treatments for some of the most common chronic conditions, covered in full or with cost-share, before deductible
  • 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®

Your out-of-pocket costs may vary based on your subsidy level from the Federally-Funded Marketplace (FFM).

Network

HMO

With an HMO, you choose a primary doctor that coordinates your care. You need to see an in-network doctor unless it's an emergency or you get prior approval. Use our Find a Doctor online directory to see if your doctor is in-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

$3,500
Individual
$7,000
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

$8,700
Individual 
$17,400
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
$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 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

$75 copayment
Retail health clinic, before deductible
$75 copayment
Urgent care, before deductible 
$250 copayment
Emergency room, 30% coinsurance 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

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.