MyPriority HMO Bronze 8150 Plan Details for 2021- HealthPocket

ZIP Code
County
Applicant Info
Applicant
Date of birth
//
Gender
male
female
Income
$

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Zip Code	48228 (edit)
Applicant	1/25/1986 Male (edit)

Insurance Type	ACA (Obamacare)
Plan Name	MyPriority HMO Bronze 8150
Plan ID	hhs-29698MI0540320
Plan Year	2020
Insurance Provider	Priority Health
Metal Level	Expanded Bronze
Plan Type	HMO
Deductible	$8,150
Out-of-Pocket Maximum	$8,150
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	$30 Copay
Specialist Visit	Not Applicable
Laboratory Outpatient and Professional Services	Not Applicable
X-rays and Diagnostic Imaging	Not Applicable
Diagnostic Imaging such as MRIs, CT, and PET scans	Not Applicable
Deductible - Family	$16300 per group
Out-of-Pocket Maximum - Family	$16300 per group

Prescription drug coverage
Generic Drugs	$5 Copay
Preferred Brand Drugs	Not Applicable
Non-Preferred Brand Drugs	Not Applicable
Specialty Drugs	Not Applicable

Access to doctors and hospitals
Provider directory URL	http://priorityhealth.prismisp.com/
Does this plan have access to a national provider network?	No
Is a referral required to see a Specialist?	Not Covered
Does this plan cover services outside plan service area?	Yes - Urgent/Emergency Care Only
Does this plan cover services outside the country?	Yes - Emergency Care Only

Hospital services
Emergency Room Services	Not Applicable
Inpatient Hospital Services (e.g., Hospital Stay)	Not Applicable
Inpatient Physician and Surgical Services	Not Applicable
Emergency Transportation or Ambulance Service	Not Applicable

Maternity
Prenatal and Postnatal Care	Not Applicable
Delivery and all inpatient services for maternity care	Not Applicable

Mental Health
Mental/Behavioral Health Outpatient Services	$30 Copay
Mental/Behavioral Health Inpatient Services	Not Applicable
Substance use disorder outpatient services	$30 Copay
Substance use disorder inpatient services	Not Applicable

Medical Management Programs
Does this plan offer disease managment programs?	Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Does this plan offer a wellness program?	Not Covered

Vision Coverage
Routine Eye Exam for Children	Included
Eye Glasses for Children	Included
Routine Eye Exam for Adults	Included

Child Dental Coverage
Child Dental Coverage - Routine Dental Care	Not Covered
Child Dental Coverage - Basic Dental Care	Not Covered
Child Dental Coverage - Orthodontia	Not Covered
Child Dental Coverage - Major Dental Care	Not Covered

Adult Dental Coverage
Adult Dental Coverage - Routine Dental Care	Not Covered
Adult Dental Coverage - Basic Dental Care	Not Covered
Adult Dental Coverage - Orthodontia	Not Covered
Adult Dental Coverage - Major Dental Care	Not Covered

Exclusions and Limitations
More Included Benefits	Other Practitioner Office Visit (Nurse, Physician Assistant) Preventive Care/Screening/Immunization Infertility Treatment Weight Loss Programs Imaging (CT/PET Scans, MRIs) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Home Health Care Services Durable Medical Equipment Applied Behavior Analysis Based Therapies Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Prosthetic Devices Radiation Reconstructive Surgery Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Autism Spectrum Disorders Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited Benefits	Skilled Nursing Facility Bariatric Surgery Outpatient Rehabilitation Services Habilitation Services Hospice Services Chiropractic Care Nutritional Counseling Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy
More Excluded Benefits	Acupuncture Cosmetic Surgery Hearing Aids Long-Term/Custodial Nursing Home Care Private-Duty Nursing Dental Check-Up for Children Routine Foot Care Abortion for Which Public Funding is Prohibited Accidental Dental

+ See All Coverage Details

Premium	Plan Name	Deductible
from $233	Ambetter Essential Care 1 (2021)	$8,300.00	Select
from $266	Ambetter Essential Care 1 (2021) + Vision + Adult Dental	$8,300.00	Select
from $266	Core Care Bronze 2	$8,000.00	Select

Last Name

Location/Distance

Please select the correct zip

William, Prechel

Satish, Khanzode

Physio Matrix Inc.

Prince, Eubanks

Prechel Family Clinic, Pc

Juanita, Williams

Halo Pediatrics

Deidre, Flowers

Neo Inc.

Javid, Khan

Janet, Lang

Iamerica Behavioral & Mental Health

View All Details

Wadeeah, Alshawi

View All Details

Deandra, Robinson

View All Details

Karen, Eddings-howell

Vannessa, Robinson

Mojtaba, Al-modhafir

Taylor, Banks

Joel, Shreve

Briana, Lamar

Roxsanna, Collins

Roslyn, Mcgee

William Prechel, D.O.

View All Details

Phone Number
(313) 584-3624
Office Locations
16551 W Warren Ave
Detroit, MI 48228

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ZIP Code
County
Applicant Info
Applicant
Date of birth
//
Gender
male
female
Income
$

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MyPriority HMO Bronze 8150

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Benefits & Coverage

Costs for Medical Care

Prescription drug coverage

Access to doctors and hospitals

Hospital services

Maternity

Mental Health

Medical Management Programs

Vision Coverage

Child Dental Coverage

Adult Dental Coverage

Exclusions and Limitations

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