MyPriority Telehealth PCP Silver 5500 - Virtual First - Off Marketplace

The MyPriority® Telehealth PCP Silver 5500 - Off-Marketplace plan is 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.

This plan is ideal for individuals or families who are looking for an affordable health plan that is virtual first and are comfortable with online and/or phone interaction with providers for care.

Members who choose a MyPriority Telehealth PCP plan will have a provider from our virtual care partner, MyPriority Virtual Primary Care Plus. You can have appointments and consultations with this provider just like you would in person. If your virtual care provider refers you to an in-person facility for health care services, you have access to the broad Priority Health HMO network.

Three important things to know about a MyPriority Telehealth PCP plan:

  • Every visit (except emergency care) begins with virtual care provided by MyPriority Virtual Primary Care Plus. You will need a smartphone or computer. When you need care, you make a virtual appointment to connect with a provider via the app or online portal.
  • This plan offers all types of 'virtual first' care: The virtual PCP acts as a primary care provider, urgent care, behavioral health, preventive health and chronic care provider.
  • You'll need a referral to seek in-person care with a PCP or specialist: This is a 'virtual first' plan. Referrals from your assigned telehealth doctor are required to seek care in a traditional office setting. In-person claims that do not have a referral from a MyPriority Virtual Primary Care Plus provider will be denied.

Your health is our top priority

Earning 4 out of 5 stars* on healthcare.gov, Priority Health gives you more for your money and does more to improve your health.

Highlights of what members get:

  • Telehealth PCP: All visits with your provider will take place virtually, all you need is a device with an internet connection.
  • On-demand mental health support: Included in your plan is myStrength, a mental health and wellness online tool that helps you live your best life.
  • Chronic condition management: Access to a variety of medications, supplies and services to help keep your chronic conditions under control—covered in full or with a low cost share, before deductible.
  • Diabetes management: Our plans provide coverage for diabetes management services, supplies and treatments for no cost, before deductible when furnished by a participating medical equipment and supplies provider. Diabetes prescriptions and testing procedures are covered before deductible, with cost share.
  • Global emergency assistance: If you or your dependents 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

With a Telehealth PCP plan, you will have a provider from MyPriority Virtual Primary Care Plus and will receive care virtually. Referrals from a telehealth provider are required to seek care in a traditional office setting, or with a specialist, as needed.

If your virtual care provider refers you to an in-person facility for health care services, you will have access to the broad Priority Health HMO 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 deductible is the amount you pay for 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

$9,100
Individual
$18,200
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.

Virtual office visits

$10 copayment
Primary doctor, before deductible
$10 copayment
Urgent care, before deductible
$10 copayment
Mental health, before deductible

Office visits are virtual, provided by MyPriority Virtual Primary Care Plus. A referral is needed to seek care in a traditional office setting or with a specialist.

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.

Emergency services

Covered in full
After deductible

When you seek treatment for an illness, injury, symptom or condition that needs immediate 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.

A referral is needed from MyPriority Virtual Primary Care Plus to seek care from another provider.

Maternity

Covered in full
Routine prenatal and postnatal care, before deductible

A referral is needed from MyPriority Virtual Primary Care Plus to seek care from another provider

Diagnostic tests, X-rays, lab services and radiology services

$10 copayment
Diagnostic tests and lab services, before deductible
30% coinsurance
X-rays and radiology services, after deductible

A referral is needed from MyPriority Virtual Primary Care Plus to seek care from another provider.

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.