MyPriority HMO Silver 3200 - Off-Marketplace

MyPriority® HMO Silver 3200 - Off-Marketplace (full or narrow network) plans are an affordable option for individuals who do not qualify for a federal subsidy, or chose 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.

Highlights of what you get:

  • Free virtual care: 24/7 non-emergency care by phone or online.
  • Prescription drugs: $20 copay for generics, before deductible.
  • Unlimited primary doctor visits: $30 primary care doctor visits, before deductible.
  • Vision coverage: Embedded vision exam and discounts, available through EyeMed.
  • 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

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

$3,200
Individual
$6,400
Family

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

Coinsurance

70%
Plan pays
30%
You 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%.

Out-of-pocket limit

$7,350
Individual
$14,700
Family

This is the most you pay during a policy period (usually a year) before Priority Health begins to pay 100% of the allowed amount. This includes your copayments, deductibles and coinsurance payments. This limit does not include your monthly premium.

Office visits

$30 copayment
Primary doctor, before deductible 
$45 copayment
Specialist, after
deductible
$75 copayment
Urgent care, before deductible

Virtual care

$0 copayment
Before deductible

24/7 non-emergency care by phone, video or online.

Free preventive care

$0 copayment

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.

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

30%
Coinsurance after deductible

Preferred generics and generic drugs

$20 copayment
Before deductible

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.