MyPriority Silver 5500 - Beaumont Health Network

MyPriority® Silver 5500 plans are a smart option for individuals or families who are healthy and savings-minded. Many common health care services like primary care visits, specialist visits, urgent care, most prescriptions and labs are available with a low copay before deductible. This plan can be purchased on the federal Marketplace or directly from Priority Health.

Your health is our top priority

Earning 4 out of 5 stars* on healthcare.gov, Priority Health gives you more for your money and does more to improve your health.

Highlights of what members get:

  • On-demand mental health support: myStrength, included at no added cost, is a mental health and wellness online tool that helps you live your best life.
  • Chronic condition management: Access to a variety of medications, supplies and services to help keep your chronic conditions under control–covered in full or with a low cost share, before deductible.
  • Diabetes management: Our plans provide coverage for diabetes management services, supplies and treatments for no cost, before deductible when furnished by a participating durable medical equipment (DME) provider. Diabetes prescriptions and testing procedures are covered before deductible, with cost share.
  • Global emergency assistance: If you or your dependents become ill or injured while traveling more than 100 miles from home, our partner Assist America® can help you get care and even arrange your safe travel home.
  • Hearing exams and hearing aids: Discounts for you and your extended family with TruHearing®

Beaumont Health Network

A narrow network offered to individuals who live in Wayne, Oakland and Macomb counties

Members who choose a Beaumont Health Network plan are required to receive care in the Beaumont Health system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc.

This network includes:

Hospitals: Beaumont Health Hospitals (including former Oakwood hospitals) – Dearborn, Farmington Hills, Grosse Pointe, Royal Oak, Taylor, Trenton, Troy, Wayne

Physicians (primary care and specialist) network:

  • Physicians employed by Beaumont Health
  • Any individual community physicians with admitting privileges at Beaumont Health that are listed as in-network in the Priority Health Beaumont Network Find a Doctor directory

All in-network pharmacies

Details:

  • A narrow network allows members to enjoy a lower monthly premium while getting access to quality care
  • No referral needed to see an in-network specialist
  • Members who enroll in this plan will see the Beaumont Health network on their ID cards
  • Care received outside of the Beaumont Health network will not be covered, and members will be required to cover the full cost for out-of-network care

Your out-of-pocket costs may vary based on your subsidy level from the Federally-Facilitated Marketplace (FFM).

Network

Beaumont Health Network

You must receive care in the Beaumont Health Network of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc. Care received outside of the Beaumont Health Network will not be covered and members will be required to cover the full cost of out-of-network care.

Emergency services are covered at the in-network level. Use our Find a Doctor online directory to see if your doctor is in the Beaumont Health Network.

Metal level

Silver

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.

Deductible

$5,500
Individual
$11,000
Family

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

Coinsurance

70%
Plan pays
30%
You pay

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.

Out-of-pocket-limit

$9,100
Individual
$18,200
Family

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.

Office visits

$30 copayment
Primary doctor, office visits (evaluation only), before deductible
$65 copayment
Specialist, office visits (evaluation only), before deductible  
$30 copayment
Mental health, office visits only, before deductible

Tier 1a and Tier 1b drugs

$5 copayment
Tier 1a
Before deductible
$20 copayment
Tier 1b
Before deductible

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

Retail health, urgent care and emergency services

$75 copayment
Retail health clinic, office visits (evaluation only), before deductible
$75 copayment
Urgent care, office visits (evaluation only), before deductible 
$250 copayment
Emergency room (waived if admitted); 30% coinsurance, after deductible

When you seek treatment for an illness, injury, symptom or condition that needs immediate care.

Limited virtual care

Covered in full
Before deductible

24/7 access to a provider with a Spectrum Health On-Demand virtual urgent care.

Preventive care

Covered in full
Before deductible

Preventive services help you avoid potential health problems or find them early when they are most treatable before you feel sick or have symptoms. See our Preventive Health Care Guidelines for a list of covered preventive services.

Maternity

Covered in full
Routine prenatal and postnatal care, before deductible

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

$10 copay
Diagnostic tests & lab services
Before deductible
30% coinsurance
X-rays & radiology services
After 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.