MyPriority HMO Silver 3200 - Spectrum Health Partners
MyPriority® HMO Silver 3200 (full or narrow network) plans are a smart option for individuals and families that don’t anticipate needing major health care services and want the reassurance of being covered for general care. This plan can be purchased on the federal Marketplace or directly from Priority Health.
Highlights of what you get:
- $0 virtual care: 24/7 non-emergency care by phone or online.
- Prescription drugs: $5 copay for preferred 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!
Spectrum Health Partners: Narrow network option for Kent County residents
Members who choose one of these plans are required to receive care in the Spectrum Health system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc.
- Spectrum Health hospitals (including those outside Kent County with the exception of Spectrum Health Lakeland)
- Spectrum Health Medical Group
- Physicians who denote a Spectrum Health hospital in Grand Rapids as their primary hospital affiliation
- Orthopedic Associates of Michigan (OAM) physicians (procedures must be done at a Spectrum Health facility)
- Ancillary facilities such as Pine Rest Christian Mental Health Services and Forest View 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 Spectrum Health Partners network on their ID cards.
- Care received outside of the Spectrum Health Partners network will not be covered and members will be required to cover the full cost for out-of-network care.
You must receive care in the Spectrum Health system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc. Emergency services are covered at the in-network level. Use our Find a Doctor online directory to see if your doctor is in the Spectrum Health Partners 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.
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
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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