MyPriority HMO Silver 3200 plan details
Use the chart below to know how much your plan covers for different health care scenarios. These amounts are tailored to your specific plan type.
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
2019 plan benefits
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. 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.