MyPriority PPO RxPlus Bronze 3975

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.

Highlights of what you get

  • $50 office visits – Any combination of up to two specialist, family doctor or urgent care visits before deductible, including related non-surgical services (like X-rays, labs, etc.)
  • $30 generic drugs – You get generic prescriptions for a $30 copayment before deductible
  • Cash rewards – Our Cost Estimator lets you shop for high-quality care at lower-priced facilities. Best of all? When you 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 a specialist.
  • Optional dental coverageTwo plans to choose from, both include annual exams and cleanings.

More about MyPriority PPO HSA Bronze 3975

Network

PPO

With a PPO, you can choose to see either in-network or out-of-network doctors. You'll pay less if you stay in-network and more if you see out-of-network doctors. Use our Find a Doctor online directory to see if your doctor is in our PPO network.

Metal level

Bronze

The metal level determines how you and your plan share the costs of care. Bronze means your plan pays 60% on average and you pay about 40%.

Deductible

$3,975
Individual
$7,950
Family

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

Coinsurance

50%
Plan pays
50%
You pay

This is the amount you pay, after deductible. Preventive health services are covered at 100%.

Out-of-pocket limit

$6,850
Individual
$13,700
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

$50 copayment
Primary doctor, specialist, urgent care

$50 copayment first 2 visits a year including onsite labs and imaging. Deductible applies after first two any office visits, then coinsurance.

Free preventive care

$0 copayment

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.

Emergency services

$250 copayment
After deductible, waived if admitted
50%
Coinsurance 

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

50% coinsurance

If the service provided is done during an office visit, 100% is covered. Deductible applies after the first two of any office visits.

Virtual visits

50% coinsurance
After deductible

Get 24/7 access to a doctor via the phone or web

Preferred generics and generic drugs

$35 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.