MyPriority Silver 3500 - Off-Marketplace

MyPriority® Silver 3500 - 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.

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®

Network

HMO

An HMO is a type of health plan that provides care through a designated network of doctors, specialists and facilities that members must use in order to be covered by the plan. 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 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

$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 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—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.