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-Facilitated Marketplace (FFM).

Network

HMO

An HMO provides care through a designated network of doctors, specialists and facilities that members must use in order to be covered by the plan. A primary care provider coordinates your care and you need to see an in-network doctor unless it's an emergency or you get prior approval.

Use our Find a Doctor tool 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

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
Before deductible

Preventive services help you avoid potential health problems or find them early when they are most treatable before you feel sick or have symptoms. 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.