MyPriority Standard Gold

MyPriority® Standard Gold is ideal if you or your family expect to visit the doctor often during the year or if you take a lot of prescriptions. You'll have a lower annual deductible and copays in exchange for a higher monthly premium.

Many common health care services like primary and urgent care visits and drugs are available with a copay before the deductible. You'll also have chronic condition and diabetes management, extra benefits and resources at low or no cost, providing comprehensive care for your physical, mental and emotional health.

Helping you stay healthy and engaged is our priority.

  • Prescription coverage: Before your deductible is met, get coverage on prescription drugs.
  • Virtual urgent care: Before your deductible is met, virtual urgent care visits are covered in full when scheduled through the Priority Health member app.
  • On-demand mental health support: Get access to a digital solution that helps with stress, anxiety, chronic pain and more. It can be self-directed or used with coaching support, available at no cost.
  • Chronic condition management: Before your deductible is met, certain services, supplies and prescriptions used to treat common long-term health conditions are covered with cost share or in full.
  • Diabetes management: Before your deductible is met, certain supplies, treatments, prescriptions and tests are covered with cost share or in full.
  • Global emergency assistance: If you become ill or injured while traveling more than 100 miles from home, our partner Assist America® will help you get care and arrange your safe travel home.
  • Care for your hearing: Get discounts for you and your extended family for hearing exams and hearing aids through TruHearing.®

Your out-of-pocket costs may vary based on your subsidy level from the Federally-Facilitated Marketplace (FFM).

Network

HMO

An HMO provides care through a designated network of doctors, specialists and facilities that members must use in order to be covered by the plan. A primary care provider coordinates your care and you need to see an in-network doctor unless it's an emergency or you get prior approval.

Use our Find a Doctor tool to see if your doctor is in-network.

Metal level

Gold

The metal level determines how you and your plan share the costs of care. Gold means your plan pays 75% (on average) and you pay about 25%.

Deductible

$1,500
Individual
$3,000
Family

The deductible is the amount you pay for in-network covered health care services before Priority Health begins to pay.

Coinsurance

75%
Plan pays
25%
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

$8,700
Individual 
$17,400
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.

Office visits

$30 copayment
Primary care
Before deductible
$60 copayment
Specialist
Before deductible
$30 copayment
Mental health
Before deductible

Tier 1a and Tier 1b drugs

$15 copayment
Tier 1a
Before deductible
$15 copayment
Tier 1b
Before deductible

Tier 1 includes low-cost generic drugs, proven to be as safe as brand-name drugs.

Urgent care and Retail health clinics

$45 copayment
Urgent care
Before deductible
$45 copayment
Retail health clinic
Before deductible

Emergency room

25% coinsurance
Emergency room
After deductible

Virtual urgent care

Covered in full
Virtual urgent care
Before deductible

See a provider through Virtual Urgent Care provided by Corewell Health. This care is accessed through your Priority Health member account and is best for treating minor illnesses and injuries like ear infections, fevers, coughs, minor burns or bites.

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.

Maternity

Covered in full
Routine prenatal and postnatal care
Before deductible

Delivery and nursery care are covered with 25% coinsurance, after deductible.

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

25% coinsurance
After deductible

The features and benefits shown on this page are intended to give you an overview of what this plan covers. For more details, please refer to the Summary of Benefits and Coverage.