MyPriority RxPlus Silver Spectrum Health Partners
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 in-network office visits, including specialists and generic drugs, before you meet your annual deductible.
What is Spectrum Health Partners?
This plan offers a narrow network available only to those who live in Kent County. You must receive care in the Spectrum Health system of doctors and hospitals. A limited network allows you to enjoy a lower monthly premium and have access to quality care. You'll need prior authorization from us to be covered for care in our full HMO network.
Highlights of what you get
- $20 office visits - Any combination of up to four specialist, family doctor or urgent care visits in-network before deductible, including related non-surgical services (like X-rays, labs, etc.)
- $5 preferred generic drugs - Preferred generics for a $5 or $10 copayment before deductible.
- FREE preventive care - Routine in-network care like well-child visits, flu shots and annual exams at no cost.
- Global emergency assistance - If you become ill or injured while traveling more than 100 miles from home our partner, Assist America, can help get you get care and even arrange your travel back home safely.
- Optional dental coverage - Two plans to choose from, both include in-network annual exams and cleanings
More about MyPriority Silver RxPlus Spectrum Health Partners
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%.
This is the amount you pay for covered in-network 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 in-network 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 in-network covered preventive services.
After deductible, waived if admitted
Diagnostic tests, X-rays, lab services and radiology services
Deductible applies after the first four of any in-network 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.