A MyPriority Balanced Silver Off Marketplace Southeast Michigan Network plan reassures you with coverage and access to routine and general care for just a copay before the annual deductible.

Plan information

The MyPriority® Balanced Silver Off Marketplace plan is a good balance between having coverage in case of a major health care need and the reassurance of access to routine and general care for just a copay before you meet your annual deductible. With certain benefits and services at low or zero cost, we'll help you balance saving money and staying healthy.

If you don't qualify for a federal subsidy – or would rather not use one – you can save money on your monthly premium by enrolling in the MyPriority Balanced Silver Off Marketplace plan directly with Priority Health. This plan comes with the same coverage as the Marketplace plan but without the associated fees.

You get coverage that supports your physical, mental and financial health:

  • Low Tier 1a and Tier 1b prescription drug copays, before deductible
  • Chronic condition management and low-cost benefits for some of the most common conditions
  • $0 preventive care
  • $0 limited virtual urgent care visits through Corewell Health Virtual Urgent Care, before deductible
  • On-demand mental health support through Teladoc Health Mental Health
  • Access to a large network of high-quality primary care providers across Michigan
  • Award-winning customer service

Network

Southeast Michigan Network

This narrow network plan is offered to individuals who live in Macomb, Oakland, and Wayne counties.

To ensure coverage of your health care costs, you must receive care from doctors and hospitals within the Southeast Michigan Network or their affiliated facilities. If you receive care from an out-of-network provider, you will be responsible for paying the full cost. Emergency services are covered at the in-network level.

Hospital networks

Corewell Health East hospitals

  • Corewell Health Dearborn Hospital
  • Corewell Health Farmington Hills Hospital
  • Corewell Health Beaumont Grosse Pointe Hospital
  • Corewell Health Taylor Hospital
  • Corewell Health Trenton Hospital
  • Corewell Health Beaumont Troy Hospital
  • Corewell Health Wayne Hospital
  • Corewell Health William Beaumont University Hospital

Trinity Health East hospitals

  • Trinity Health Ann Arbor Hospital
  • Trinity Health Chelsea Hospital
  • Trinity Health Livingston Hospital
  • Trinity Health Livonia Hospital
  • Trinity Health Oakland Hospital

Physician networks (primary care and specialist)

Corewell Health East hospitals

  • Physicians employed by Corewell Health in Southeast Michigan
  • Any individual community physician with admitting privileges at Corewell Health who is in-network and listed in the Priority Health Southeast Michigan Network Find a Doctor directory.

Trinity Health East hospitals

Any individual community physician with admitting privileges at Trinity Health, including:

  • McAuley Health Partners
  • IHA OOMA
  • Oakland Physicians Network Services (OPNS)
  • Oakland Southfield Physicians
  • Huron Valley Physician Association (HVPA), also known as Village MD
  • Livingston Physician Organization (LPO)
  • Olympia

Use our online Find a Doctor directory to check if your doctor is in-network. Change the search parameters from All plans to Southeast Michigan Network.

Metal level

The metal level determines how you and your plan share the costs of care. Silver generally means moderate monthly premiums and moderate out-of-pocket costs when you receive care.

Silver

Deductible

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

Individual

$3,400

Family

$6,800

Coinsurance

Coinsurance is the percentage of the cost of medical services you have to pay after you've met your deductible. Some services–like preventive care and chronic condition management–are accessible with low or no coinsurance before you meet your deductible.

Plan pays

70%

You pay

30%

Out-of-pocket limit

This is the most you'll pay for covered health care expenses in one year. This amount includes deductibles, coinsurance and copayments for covered services.

Individual

$9,000

Family

$18,000

Tier 1a and Tier 1b drugs

Tier 1 includes low-cost generic drugs, proven to be as safe as brand-name drugs.

Tier 1a

$5 copayment

Before deductible

Tier 1b

$20 copayment

Before deductible

Doctor visits, ER and Urgent care

Primary care

$30 copayment

Before deductible | Evaluation only

Specialist

$70 copayment

Before deductible | Evaluation only

Mental health

$30 copayment

Before deductible | Initial outpatient mental health visit is covered in full, before deductible.

Urgent care

$75 copayment

Before deductible

Retail health clinic

$75 copayment

Before deductible

Emergency room

$250 copay + 30% coinsurance

After deductible | Emergency room copayment is waived if admitted.

Virtual care

See a provider through Corewell Health Virtual Urgent Care. This care is accessed through your Priority Health member account and is best for treating minor illnesses and injuries like ear infections, fevers, coughs, minor burns or bites.

Virtual urgent care

Covered in full

Before deductible

Services

Diagnostic tests

30% coinsurance

After deductible

Labs

30% coinsurance

After deductible

X-rays

30% coinsurance

After deductible

Radiology services

30% coinsurance

After deductible

Chiropractic manipulation

30% coinsurance

After deductible | Chiropractic manipulation benefits cover 30 visits per year, including maintenance visits.

Outpatient physical & occupational therapy

30% coinsurance

After deductible | Physical therapy and occupational therapy have a combined limit of 30 visits per year.

Preventive care

Covered in full

Before deductible

Maternity | Routine prenatal and postnatal care

Covered in full

Before deductible | Delivery and nursery care are covered with 30% coinsurance, after deductible.

The features and benefits shown on this page are intended to give you an overview of what this plan covers. For more details, please refer to the Summary of Benefits and Coverage.

Attention: This website is operated by Priority Health and is not the Health Insurance Marketplace® website at HealthCare.gov. This website does not display all Qualified Health Plans (QHPs) available through HealthCare.gov. To see all available QHP options, go to the Health Insurance Marketplace website at HealthCare.gov.

Also, you should visit the Health Insurance Marketplace website at HealthCare.gov if:

  • You want to select a catastrophic health plan

1CMS scores qualified health plans (QHPs) offered through the Exchanges using the Quality Rating System (QRS) based on third-party validated clinical measure data and QHP Enrollee Survey responses. CMS calculates QRS ratings yearly on a 5-star scale. QHP issuers work with HHS-approved survey vendors that independently conduct the survey each year. QRS ratings and QHP Enrollee Survey results may change from year to year.