MyPriority Standard Silver

The MyPriority® Standard Silver plan is a dependable option that gives you access to certain office visits, services, and prescription drugs for a copay before you reach your annual deductible.

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

  • $20 copay for tier 1 prescriptions, before deductible
  • $40 copay for primary care visits, before deductible
  • $80 copay for specialist visits, before deductible
  • $0 limited virtual urgent care visits through Corewell Health Virtual Urgent Care, before deductible
  • Chronic condition management and diabetes management, 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

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

Network

HMO

An HMO provides care through a designated network of doctors, specialists and facilities that members must use in order to be covered by the plan. A primary care provider coordinates your care and you need to see an in-network doctor unless it's an emergency or you get prior approval.

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

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

$5,000
Individual
$10,000
Family

The deductible is the amount you pay for 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

$8,000
Individual
$16,000
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

$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.

Urgent care and Retail health clinics

$60 copayment
Urgent care
Before deductible
$60 copayment
Retail health clinic
Before deductible

Emergency room

40% coinsurance
Emergency room
After deductible

Virtual urgent care

Covered in full
Virtual urgent care
Before deductible

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.

Rehabilitation services

$40 copayment
Chiropractic manipulation
Before deductible
$40 copayment
Outpatient physical/occupational therapy
Before deductible

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

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

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

Delivery and nursery care are covered with 40% coinsurance, after deductible.

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

40% 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.