MyPriority Silver 3200 - Spectrum Health Partners

Individual Health Insurance (Obamacare)

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MyPriority Silver 3200 - Spectrum Health Partners

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Benefits & Coverage

Plan Name
MyPriority Silver 3200 - Spectrum Health Partners
Plan Year
2018
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Silver
Out-of-Pocket Maximum
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness
$30 Copay
Specialist Visit
$45 Copay after deductible
Laboratory Outpatient and Professional Services
30.00% Coinsurance after deductible
X-rays and Diagnostic Imaging
30.00% Coinsurance after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans
$150 Copay after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Deductible - Family
$6400 per group
Out-of-Pocket Maximum - Family
$14700 per group

Prescription drug coverage

Generic Drugs
$20 Copay
Preferred Brand Drugs
$75 Copay after deductible
Non-Preferred Brand Drugs
$100 Copay after deductible
Specialty Drugs
50.00% Coinsurance after deductible

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
$250 Copay after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Hospital Services (e.g., Hospital Stay)
$500 Copay per Day after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Inpatient Physician and Surgical Services
30.00% Coinsurance after deductible
Emergency Transportation or Ambulance Service
$250 Copay after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.

Maternity

Prenatal and Postnatal Care
Not Applicable
Delivery and all inpatient services for maternity care
30.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services
$30 Copay
Mental/Behavioral Health Inpatient Services
$500 Copay per Day after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is applicable.
Substance use disorder outpatient services
$30 Copay
Substance use disorder inpatient services
$500 Copay per Day after deductible, 30.00% Coinsurance after deductible. See plan brochure for when Copay is 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 Facility Fee (e.g., Ambulatory Surgery Center)
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
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

What To Know

  • This is an ACA (Obamacare) compliant health plan.

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Silver plan frequently asked questions (FAQ)

  • What Is the Silver Plan?

    ObamaCare’s Silver Plan is a type of Metal Plan on the Health Insurance Marketplace. Silver Plans qualify for both Tax Credits and Cost Sharing subsidies.Silver Plans have lower out-of-pocket costs than Bronze Plans but higher out- of-pocket costs than both Gold and Platinum Plans. All Silver Plans share the same minimum health benefits, but the way they charge out-of-pocket costs can differ significantly.

  • How are Silver Plans different than other Obamacare health plans?

    The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Silver Plan pays 70% of covered medical costs for a typical enrollee. Silver Plans are also the only metal plans which offer cost-sharing reduction (CSR) versions to consumers that require financial assistance for out-of-pocket costs.

  • How much does a Silver Plan cost?

    The monthly premium for a Silver Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Silver Plan premiums in your area.

  • When Can I Enroll in a Silver Plan?

    The Open Enrollment period for the 2016 Affordable Care Act health plans begins November 1, 2015 and ends January 31, 2016. See our Open Enrollment article for more information.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. 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. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.

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