Tiered networks

These networks have cost-sharing "tiers"

Tier 1: Tiered networks are set up to offer plan members savings when they go to Tier 1 providers. Members will benefit from lower coinsurance, copays and deductibles when receiving care through a Tier 1 provider.

Tier 2: Members still have access to the entire Priority Health network. However, care received from Tier 2 providers requires greater member cost-sharing.

Tier 3:

  • POS members also have Tier 3, which are alternate benefits, at the highest cost-sharing.
  • HMO members have no Tier 3 or out-of-network alternate benefits.

Provider responsibility

Help patients get the most out of their plan and pay the best price by referring them to providers within the Tier 1 network. Use Find a Doctor to see which providers are in your patients' networks.

  1. Click "All Plans" in the upper right corner.
  2. Select "Find a Different Plan." 
  3. Select the appropriate plan name below (West MI Partners, Southeast MI Partners or Corewell Health Employer Group).

Care that HMO members receive from outside their network will not be covered. Patients will be liable for the full cost, except in certain transplant and emergency situations, and in instances where services are not available within their network.

Tiered network: West MI Partners (WMP)

Available to: West Michigan large and small employer groups within the counties listed below, multiple plans available

Identification: Member ID cards indicate "West MI Partners"

West Michigan Partners TN card.png

Counties:

  • Large and small groups: Allegan, Barry, Calhoun, Kalamazoo, Kent, Lake, Mason, Mecosta, Montcalm, Newaygo, Osceola, Ottawa and Van Buren
  • Large groups only (in addition to above): Ionia, Muskegon, Oceana

Tier 1 in-network providers:

Providers and Tier levels are subject to change. Use the Find a Doctor tool to find and verify Tier 1 providers by selecting West MI Partners as the plan. In the search results, these providers will show as Tier 1. Tier 1 includes:

  • Health systems: Corewell Health in West Michigan (excluding Corewell Health in Southwest Michigan, formerly Spectrum Health Lakeland), Holland Hospital, University of Michigan Health-West and Bronson Healthcare.
  • Physicians: Providers with admitting privileges and affiliated with the health systems listed above. 
  • Ancillary facilities: Tier 1 includes a broad selection of free-standing, lower-cost facilities.

Tier 2 in-network providers:

Tier 2 includes contracted providers beyond those in Tier 1. You can identify them in the Find a Doctor tool. These providers will show as Tier 2.

Tiered network: Corewell Health Employer Group

Available to: Corewell Health employees and dependents in the counties listed below.

Identification: Member ID cards indicate "Corewell Health Employer Group"

Corewell Health Employer Group TN card.png

Counties:

  • Allegan, Barry, Berrien, Cass, Ionia, Kent, Lake, Macomb, Mason, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Osceola, Ottawa, Van Buren, Washtenaw, Wayne

Tier 1 in-network providers:

Providers and Tier levels are subject to change. Use the Find a Doctor tool to find and verify Tier 1 providers by selecting Corewell Health Employer Group as the plan. In the search results, these providers will show as Tier 1. Tier 1 includes:

  • Hospitals: All Corewell Health hospitals; Holland Hospital; and owned surgery centers and free-standing campus locations that provide diagnostic services
  • Physicians: Corewell Health Medical Group; Holland Physician Hospital Organization; Answer Health shareholders and affiliates; Health Pointe; Mary Free Bed; We Are For Children; Neonatal Associates; Pediatric Surgeons of West Michigan; pathology, anesthesiology, radiology and emergency room physicians serving a Corewell Health or Holland hospital; and all behavioral health providers
  • Ancillary facilities:
    • Acute rehabilitation facilities
    • Ambulance services
    • Chiropractors
    • Dialysis facilities
    • Durable medical equipment (DME)
    • Health departments
    • Home infusion
    • Infusion associates
    • Mary Free Bed at Home
    • Prosthetics and orthotics

Tier 2 in-network providers:

Tier 2 includes contracted providers beyond those in Tier 1. You can identify them in the Find a Doctor tool. These providers will show as Tier 2.

Tiered network: Southeast MI Partners

Available to: Southeast Michigan large and small employer groups in six Michigan counties, multiple plans available

Identification: Member ID cards indicate "Southeast MI Partners"

SE Michigan Partners TN card.png

Counties:

  • Livingston, Macomb, Oakland, St. Clair, Washtenaw, Wayne

Tier 1 in-network providers:

Providers and Tier levels are subject to change. Use the Find a Doctor tool to find and verify Tier 1 providers by selecting Southeast MI Partners as the plan. In the search results, these providers will show as Tier 1. Tier 1 includes:

  • Health systems: Ascension in Southeast MI, Corewell Health in Southeast Michigan (formerly Beaumont Health), Detroit Medical Center, Lake Huron Medical Center, Michigan Medicine (for non-primary care with referral only), Trinity Health in Southeast Michigan.
  • Physicians: Select physicians affiliated with the health systems above. 
  • Ancillary facilities: Tier 1 includes a broad selection of free-standing, lower cost facilities.

Tier 2 in-network providers:

Tier 2 includes contracted providers beyond those in Tier 1. You can identify them in the Find a Doctor tool. These providers will show as Tier 2.