MyPriority HMO Silver 5500 - St. John Providence Network
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 and brand 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: Tier 1-Tier 3 drugs before deductible
- Chronic condition management: Services, supplies, and treatments for some of the most common chronic conditions, with cost-share, 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
St. John Providence Network: Narrow network option for residents of Wayne, Oakland and Macomb counties
Members who choose a St. John Providence Network plan are required to receive care in the St. John Providence system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc.
The network includes:
- Ascension St. John Hospital
- St. John Macomb-Oakland Hospital (Macomb Center)
- St. John Macomb-Oakland Hospital (Oakland Center)
- Ascension Providence Park Hospital (Southfield Campus)
- Crittenton Hospital Medical Center
- St. John River District Hospital
- Ascension Providence Park Hospital (Novi Campus)
- Affiliated partners
Physicians who are affiliated with Ascension-St. John Providence groups listed below:
- St. John and St. John North Shore
- St. John River District
- St. John Oakland
- St. John Macomb
- St. John Cornerstone
- Providence Hospital
All in-network pharmacies
- A narrow network allows members to enjoy a lower monthly premium while getting access to quality care.
- Members who enroll in this plan will see the St. John Providence network on their ID cards.
- Care received outside of the St. John Providence network will not be covered, and members will be required to cover the full cost for out-of-network care.
Your out-of-pocket costs may vary based on your subsidy level from the Federally-Funded Marketplace (FFM).
Members must receive care in the St. John Providence Network system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc. Care received outside of the St. John Providence Network will not be covered and members will be required to cover the full cost of out-of-network care.
Emergency services are covered at the in-network level. Use our Find a Doctor online directory to see if your doctor is in the St. John Providence Network.
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.
The amount you pay for covered health care services before Priority Health begins to 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%.
Your annual maximum cost. The most you'll pay for health care services including copays and prescription drugs in one year.
Primary doctor, before deductible
Urgent care, before deductible
24/7 non-emergency care by mobile device or online.
After deductible, waived if admitted
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
Tier 1a and Tier 1b drugs
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.
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