MyPriority HMO RxPlus Gold 800
Our MyPriority® RxPlus plans are designed for people who want the best coverage for their money or may be transitioning from employer-provided insurance to buying direct. You get immediate, affordable access to office visits, including specialists and generic drugs, before you meet your annual deductible.
This plan is only available to those who live in Kent County.
Highlights of what you get
- $20 office visits – Any combination of up to four specialist, family doctor or urgent care visits before deductible, including related non-surgical services (like X-rays, labs, etc.)
- Prescription drugs - $5 preferred generics or $10 generics before deductible
- Cash rewards – Our Cost Estimator lets you shop for high-quality care at lower-priced facilities. Best of all? When you shop and then receive care at a fair-price facility, we'll send you a Visa® reward card.
- No referral needed – Our plans don't require a referral to see an in-network specialist.
- Optional dental coverage – Two plans to choose from, both include annual exams and cleanings.
More about MyPriority HMO RxPlus Gold 800
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.
The metal level determines how you and your plan share the costs of care. Gold means your plan pays 80% on average and you pay about 20%.
The amount you pay for in-network covered health care services before Priority Health begins to pay.
This is the amount you pay in-network, after deductible. Preventive health services are covered at 100%.
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, specialist, urgent care
$20 copayment first 4 visits a year including onsite labs and imaging. Deductible applies after first four any office visits, then coinsurance.
Free preventive care
Routine care helps keep you and your family healthy. That's why we cover preventive care like well-child visits, flu shots and annual exams at no cost. See our Preventive Health Care Guidelines for a list of covered preventive services.
Waived if admitted
Diagnostic tests, X-rays, lab services and radiology services
If the service provided is done during an office visit, 100% is covered. The deductible applies after the first four of any office visits.
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.