MyPriority Standard Silver 5800 - Ascension St. John Providence Network

MyPriority® Standard Silver 5800 is a standardized plan, offered by qualified health plans (QHPs) on the federal Marketplace. Standard plans have uniform plan designs with the same cost-sharing parameters from issuer to issuer, making plan choice and comparison simpler for enrollees. These standard plans allow consumers to more easily find the right form of quality, affordable health coverage for their circumstances.

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®

Ascension St. John Providence Network

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

Members who choose an Ascension St. John Providence Network plan are required to receive care in the Ascension St. John Providence system of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc.

This network includes:

Hospitals: Ascension Macomb-Oakland Hospital – Madison Heights Campus, Ascension Macomb-Oakland Hospital – Warren Campus, Ascension River District Hospital, Ascension Providence Rochester Hospital, Ascension Providence Hospital – Novi Campus, Ascension Providence Hospital – Southfield Campus, Ascension St. John Hospital

Physicians (primary care and specialist) network: Physicians who are affiliated with the Ascension St. John Providence groups listed below:

  • Ascension St. John and St. John North Shore
  • Ascension St. John River District
  • Ascension St. John Oakland
  • Ascension St. John Macomb
  • Ascension St. John Cornerstone
  • Ascension Providence Hospital

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 Ascension St. John Providence network on their ID cards
  • Care received outside of the Ascension St. John Providence 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

Ascension St. John Providence Network

Members must receive care in the Ascension St. John Providence Network of doctors and hospitals and their affiliated clinics, outpatient facilities, labs, etc. Care received outside of the Ascension St. John Providence 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 Ascension St. John Providence 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

$5,800
Individual
$11,600
Family

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

Coinsurance

60%
Plan pays
40%
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

$8,900
Individual
$17,800
Family

Your annual maximum cost. The most you'll pay for health care services including copays and prescription drugs in one year.

Office visits

$40 copayment
Primary doctor
(evaluation only)
Before deductible
$80 copayment
Specialist
(evaluation only)
Before deductible
$40 copayment
Mental health
Before deductible
 

Tier 1a and Tier 1b drugs

$20 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

$60 copayment
Retail health clinic, office visits (evaluation only), before deductible
$60 copayment
Urgent care, office visits (evaluation only), before deductible
40% coinsurance
Emergency room, 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, X-rays, lab services and radiology services

40% coinsurance
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.