MyPriority Silver 5500 - St. Joseph Mercy Health System Network
MyPriority® 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, most prescriptions and labs are available with a low copay before deductible. This plan can be purchased on the federal Marketplace or directly from Priority Health.
Highlights of what members get:
- On-demand mental health support: myStrength is a free 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 durable medical equipment (DME) 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®
St. Joseph Mercy Health System Network: Narrow network option for residents of Wayne, Oakland, Macomb, Washtenaw and Livingston counties
Members who choose a St. Joseph Mercy Health System Network plan are required to receive care in the St. Joseph Mercy Health System network of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc.
The network includes:
- St. Joseph Mercy Chelsea Hospital
- St. Joseph Mercy Hospital
- St. Joseph Mercy Livingston Hospital
- St. Joseph Mercy Oakland Hospital
- St. Mary Mercy Livonia Hospital
- Affiliated partners
Physicians who are affiliated with St. Joseph Mercy groups as listed below:
- Huron Valley Physician Association
- Oakland Physician Network Services – with St. Joseph Mercy Oakland designated as the primary hospital
- Livingston Physician Organization
- St. Mary Mercy Physician Practices
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. Joseph Mercy Health System network on their ID cards.
- Care received outside of the St. Joseph Mercy Health System 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-Facilitated Marketplace (FFM).
Members must receive care in the St. Joseph Mercy Health System Network system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc. Care received outside of the St. Joseph Mercy Health System 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. Joseph Mercy Health System 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
Specialist, before deductible
Mental health, before deductible (initial visit covered in full)
Limited virtual care
24/7 access to a doctor with a Spectrum Health On-Demand Video Visit.
Preventive care includes specific health care services that help you avoid potential health problems or find them early when they are most treatable, before you feel sick or have symptoms. Examples of preventive care include flu shots, physical exams, lab tests and some prescriptions. See our Preventive Health Care Guidelines for a list of covered preventive services.
Retail health, urgent care and emergency services
Retail health clinic, before deductible
Urgent care, before deductible
Emergency room, 30% coinsurance after deductible
An illness, injury, symptom or condition that needs immediate care to avoid the worsening of the condition.
Diagnostic tests, lab services, X-rays and radiology services
Diagnostic tests and lab services, before deductible
X-rays and radiology services, after deductible
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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