MyPriority HMO Silver 3200 - Off-Marketplace - St. John Providence Network
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
- 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:
- St. John Hospital and Medical Center
- St. John Macomb-Oakland Hospital (Macomb Center)
- St. John Macomb-Oakland Hospital-Oakland Center (Madison Heights campus)
- St. John Macomb-Oakland Hospital (Warren Campus)
- Providence Park Hospital (Southfield campus)
- Crittenton Hospital and Medical Center
- St. John River District Hospital
- Providence Park Hospital (Novi campus)
- Affiliated partners
All 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.
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%.
This is the amount you pay for in-network 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%.
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.
Primary doctor, before deductible
Specialist, deductible applies
Urgent care, before deductible
24/7 non-emergency care by phone, video or online.
Free preventive care
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.
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
Coinsurance after deductible
Preferred generics and generic 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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