Insurance Type | ACA (Obamacare) |
Plan Name | MyPriority Bronze 8700 - St. Joseph Mercy Health System Network |
Plan ID | hhs-29698MI0540515 |
Plan Year | 2021 |
Insurance Provider | Priority Health |
Metal Level | Expanded Bronze |
Plan Type | HMO |
Deductible | $8,700 |
Out-of-Pocket Maximum | $8,700 |
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 | $17400 per group |
Out-of-Pocket Maximum - Family | $17400 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 | $0 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 | Not Covered |
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 | [object Object] |
Premium | Plan Name | Deductible | |
---|---|---|---|
from $1,445 | MyPriority Bronze 8700 - Bronson Healthcare Partners | $8,700.00 | Select |
from $172 | HAP Personal Alliance HMO Genesys Choice Catastrophic 8550 | $8,550.00 | Select |
from $199 | Blue Cross Preferred HMO Value | $8,700.00 | Select |
from $220 | McLaren Young Adult/Catastrophic | $8,550.00 | Select |
from $223 | MyPriority HMO Bronze 8550 - St. John Providence Network | $8,550.00 | Select |
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HealthPocket.com is a free information source. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. While on our site, if you click on a plan or link, you may be directed to one of our partners who offers health insurance products. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.
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