MyPriority HMO Silver 5500 - Off-Marketplace

MyPriority® HMO Silver 5500 (full or narrow network) plans are a smart option for individuals or families who are healthy and savings-minded. Many common health care services like primary care visits, specialist visits, urgent care, generic prescriptions and labs are available with a low copay before deductible.

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 1-Tier 3 drugs before deductible
  • Primary doctor visits: $30 primary care doctor visits before deductible
  • Specialist visits: $65 specialist visit 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

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

$5,500
Individual
$11,000
Family

The amount you pay for 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

$8,550
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
$65 copayment
Specialist,
before deductible
$75 copayment
Urgent care, before deductible

Virtual care

$0 copayment
Before deductible

24/7 non-emergency care by mobile device or online.

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

$10 copay
Before 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.