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12019 CONSUMER PRODUCT GUIDE

Choose MyPriorityIndividual and family plans

2019

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Buying your own health insurance?We can help. MyPriority plans are designed to give you control of your health care spending and the peace of mind that comes with knowing you're covered.


Plans explained

Plans we offer

Dental

What plan is right for me?

Membership features

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26

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Contents

For coverage beginning Jan. 1, 2019, you can enroll between Nov. 1, 2018 and Dec. 15, 2018.

See prices and enroll

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Contact a licensed Priority Health agent

Visit mypriority.com

Call our enrollment specialists at 833.514.11068:00 a.m. – 8 p.m., Monday – Friday

9:00 a.m. – 1 p.m., Saturday and Sunday

Visit one of our customer information centers:Grand Rapids

8:30 a.m. – 5 p.m., Monday – Friday

1257 East Beltline NE, Grand Rapids, MI 49525

Holland

8:30 a.m. – 5 p.m., Monday – Friday

250 East 8th Street, Holland, MI 49423

Parking lot on 9th Street

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MyPriority HMO plans explainedMyPriority HMO plans offer low-cost premiums and help you stay healthy by making sure you have a primary doctor to coordinate your care. With our statewide network of doctors and hospitals, you can rest assured your care is covered.

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Important health insurance terms

Deductible

The amount you pay for covered in-network health

care services before we begin to pay.

Coinsurance

The percent you pay for in-network health care

services, generally after you meet your deductible.

In-network

This refers to providers or health care facilities that

are part of our network of providers. You get the

most out of your health insurance plan when you

visit in-network doctors and facilities because we’ve

already negotiated a discounted rate for services.

Out-of-network

This refers to providers or health care facilities that

are not a part of our network of providers. You will pay

a larger percentage or the total cost of care received

from out-of-network doctors and facilities.

Out-of-pocket limit

This is the most you pay during a policy period

before we begin to pay 100% of the allowed amount.

This includes your copayments, deductibles and

coinsurance payments. This limit does not include

your monthly premium.


Plan designPlan designs help

narrow your choices

based on your personal

health needs.

NetworkIf a plan comes with a

narrow network, the plan

name will list the hospital

system where members

must receive care.

These plans offer a

lower monthly premium

and access to quality

care within one

health system.

Deductible

The plan name lists

the individual deductible,

which is always half of the

family deductible.

Generally the higher the

deductible, the lower the

monthly premium you’ll pay.

Metal levelUsed as an

indicator of costs.

Bronze – generally

you pay less premium, but

more out-of-pocket costs

at time of service.

Silver – good balance

of premium and out-of-

pocket costs.

Gold – you pay more

premium, but less

out-of-pocket costs at

time of service.

Understanding MyPriority plans by name

Each plan name describes a few details of what the plan includes.

Here’s an example:

MyPriority HMO HSA Bronze 6750 Spectrum Health Partners

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MyPriority HMO Silver 3200 — Off-Marketplace

MyPriority HMO Silver 3200 — Off-Marketplace (full or narrow network) plans are an affordable

option for individuals who do not qualify for a federal subsidy or choose not to use it. It offers a lower

monthly premium because you purchase it directly from Priority Health and avoid fees associated with

plans offered on the federally run Marketplace.

MyPriority HMO Silver 3200

MyPriority HMO Silver 3200 (full or narrow network) plans are a smart option for individuals

and families that don’t anticipate needing major health care services and want the reassurance

of being covered for general care. This plan can be purchased on the federal Marketplace or

directly from Priority Health.

Highlights of what you get with both:

• Free virtual care: 24/7 non-emergency care by phone or online

• Prescription drugs: $5 copay for preferred generics before deductible

• Unlimited primary doctor visits: $30 primary care doctor visits before deductible

• Urgent care: $75 urgent care visits before deductible

• Cost Estimator: Access to our tool to see prices for hundreds of services and procedures

• Active&Fit Direct™: Discounted prices for gym memberships and more

MyPriority HMO plans explained



MyPriority HMO HSA Silver 3000 — Off-Marketplace

MyPriority HMO HSA Silver 3000 — Off-Marketplace (full or narrow network) plans are an

affordable option for individuals who do not qualify for a federal subsidy or choose not to use it. It offers

a lower monthly premium because you purchase it directly from Priority Health and avoid fees associated

with plans offered on the federally run Marketplace. Keep in mind you pay 100% of the cost of your health

care out-of-pocket until you meet your deductible.

MyPriority HMO HSA Bronze 6750

MyPriority HMO HSA Bronze 6750 (full or narrow network) plans are an affordable choice if you’re

generally healthy and savings-minded. This plan has a higher deductible than Silver plans, but a lower

monthly premium. Keep in mind you pay 100% of the cost of your health care out of pocket until your

deductible is met.

Highlights of what you get with both:

• Free HSA banking partner: HealthEquity® sets up and helps you manage your HSA banking account

• Cost Estimator: Access to our tool to see prices for hundreds of services and procedures

• Active&Fit Direct™: Discounted prices for gym memberships and more

• Virtual care: 24/7 non-emergency care by phone or online for only $45 (deductible applies)

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Narrow network plan options

Our Bronze and Silver plans come with narrow network plan options for individuals who live

in designated counties. These plans offer a lower monthly premium and require members to

receive care at facilities within the narrow network of doctors and affiliated providers. Care

received outside of the network will not be covered, and members will be required to cover

the full cost for out-of-network care.

Spectrum Health Partners

Offered to individuals who live in Kent County

This network includes:

Hospitals: All Spectrum Health hospitals, including those outside of Kent County

Physicians (primary care and specialist) network: Spectrum Health Medical

Group, physicians who denote a Spectrum Health hospital as their primary hospital affiliation

Other facilities: Orthopedic Associates of Michigan (OAM) physicians (procedures

must be done at a Spectrum Health facility)

All ancillary facilities in the Priority Health network will be available in the Spectrum

Health Partners network as well. Examples include Mary Free Bed Rehabilitation

Hospital, Pine Rest Christian Mental Health Services and Forest View Hospital.

All in-network pharmacies

PRESQUE ISLECHEBOYGAN

OTSEGO

CHARLEVOIX

MONTMORENCY

ALPENA

OSCODA ALCONA

OGEMAW

ISABELLA

GLADWIN

HURON

SAGINAW

GENESEESHIAWASSEE

LAPEER

OAKLAND

MACOMB

LIVINGSTONINGHAM

VAN BUREN

BERRIEN CASS ST. JOSEPH BRANCHHILLSDALE LENAWEE

MONROE

KALAMAZOO CALHOUN JACKSON WASHTENAW

WAYNE

ST. CLAIR

SANILAC

MIDLAND

BAY

ARENAC

IOSCO

EMMET

ANTRIM

KALKASKAGRAND

TRAVERSE

LEELANAU

BENZIE CRAWFORD

MANISTEE WEXFORD MISSAUKEE ROSCOMMON

LAKEMASON

OCEANA

NEWAYGO

MECOSTA

MONTCALM

KENT IONIAOTTAWA

BARRY

MUSKEGON GRATIOT

CLINTON

EATONALLEGAN

OSCEOLACLARE

TUSCOLA

CHEBOYGAN

OTSEGO

CHARLEVOIX

MONTMORENCY

OSCODA

OGEM

ISABELLA

GLADWIN

SAGINA

SHIAWASSEE

INGHAM

VAN BUREN

BERRIEN CASS ST. JOSEPH BRANCHHILLSDALE LENA

KALAMAZOO CALHOUN JACKSON

MIDLAND

EMMET

ANTRIM

KALKASKAGRAND

TRAVERSE

LEELANAU

BENZIE CRAWFORD


LAKEMASON

OCEANA

NEWAYGO

MECOSTA

MONTCALM

KENT IONIAOTTAWA

BARRY

MUSKEGON GRATIOT

CLINTON

EATONALLEGAN

OSCEOLACLARE


Bronson Healthcare Partners Offered to individuals who live in Kalamazoo, Van Buren and a portion of Calhoun counties


Hospitals: Bronson Methodist Hospital, Bronson Battle Creek Hospital,

Bronson Lakeview Hospital

Physicians (primary care and specialist) network: Bronson Healthcare physicians,

Bronson hospitals employed physicians, all physicians who denote Bronson Hospital

(all campuses) as their primary affiliation


OTSEGO

CHARLEVOIX

MONTMORENCY

ALPENA

OSCODA ALCONA

OGEMAW

ISABELLA

GLADWIN

HURON

SAGINAW

GENESEESHIAWASSEE

LAPEER

OAKLAND

MACOMB

LIVINGSTONINGHAM

VAN BUREN


MONROE


WAYNE

ST. CLAIR

SANILAC

MIDLAND

BAY

ARENAC

IOSCO

EMMET

ANTRIM

KALKASKAGRAND

TRAVERSE

LEELANAU

BENZIE CRAWFORD


LAKEMASON

OCEANA

NEWAYGO

MECOSTA

MONTCALM

KENT IONIAOTTAWA

BARRY

MUSKEGON GRATIOT

CLINTON

EATONALLEGAN

OSCEOLACLARE

TUSCOLA

OSCODA

OGEMAW

ISABELLA

GLADWIN

SAGINA

SHIAWASSEE

LIVINGSTONINGHAM

VAN BUREN

BERRIEN CASS ST. JOSEPH BRANCHHILLSDALE LENA

KALAMAZOO CALHOUN JACKSON

MIDLAND

BA

KALKASKAGRAND

TRAVERSE

LEELANAU

BENZIE CRAWFORD


LAKEMASON

OCEANA

NEWAYGO

MECOSTA

MONTCALM

KENT IONIAOTTAWA

BARRY

MUSKEGON GRATIOT

CLINTON

EATONALLEGAN

OSCEOLACLARE

ZIP codes in Calhoun County where the Bronson Healthcare Partners narrow network is offered: 49011, 49014, 49015, 49017, 49021, 49029, 49033, 49037, 49051, 49052, 49068, 49076, 49092, 49094

Beaumont Health Network

Offered to individuals who live in Wayne, Oakland and Macomb counties


Hospitals: Beaumont Health Hospitals (including former Oakwood hospitals) –

Dearborn, Farmington Hills, Grosse Pointe, Royal Oak, Taylor, Trenton, Troy, Wayne

Physicians (primary care and specialist) network:

All physicians employed by Beaumont Health

Any individual community physicians with admitting privileges at Beaumont Health that

are listed as in network in the Priority Health Beaumont Network Find a Doctor directory


OTSEGO

CHARLEVOIX

MONTMORENCY

ALPENA

OSCODA ALCONA

OGEMAW

ISABELLA

GLADWIN

HURON

SAGINAW

GENESEESHIAWASSEE

LAPEER

OAKLAND

MACOMB

LIVINGSTONINGHAM

VAN BUREN


MONROE


WAYNE

ST. CLAIR

SANILAC

MIDLAND

BAY

ARENAC

IOSCO

EMMET

ANTRIM

KALKASKAGRAND

TRAVERSE

LEELANAU

BENZIE CRAWFORD


LAKEMASON

OCEANA

NEWAYGO

MECOSTA

MONTCALM

KENT IONIAOTTAWA

BARRY

MUSKEGON GRATIOT

CLINTON

EATONALLEGAN

OSCEOLACLARE

TUSCOLA


OTSEGO

CHARLEVOIX

MONTMORENCY

ALPENA

OSCODA ALCONA

OGEMAW

ISABELLA

GLADWIN

HURON

SAGINAW

GENESEESHIAWASSEE

LAPEER

OAKLAND

MACOMB

LIVINGSTONINGHAM

VAN BUREN


MONROE


WAYNE

ST. CLAIR

SANILAC

MIDLAND

BAY

ARENAC

IOSCO

EMMET

ANTRIM

KALKASKAGRAND

TRAVERSE

LEELANAU

BENZIE CRAWFORD


LAKEMASON

OCEANA

NEWAYGO

MECOSTA

MONTCALM

KENT IONIAOTTAWA

BARRY

MUSKEGON GRATIOT

CLINTON

EATONALLEGAN

OSCEOLACLARE

TUSCOLA

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St. John Providence Network

Offered to individuals who live in Wayne, Oakland and Macomb counties


Hospitals: St. John Hospital and Medical Center, St. John Macomb-Oakland

Hospital (Macomb Center), St. John Macomb-Oakland Hospital-Oakland Center

(Madison Heights campus), St. John Macomb: Oakland Hospital (Warren Campus),

Providence Park Hospital (Southfield campus), Crittenton Hospital and Medical

Center, St. John River District Hospital, Providence Park Hospital (Novi campus)

Affiliated providers


All physicians who are affiliated with Ascension-St. John Providence

groups listed below:

St. John and St. John North Shore

St. John River District

St. John Oakland



All of the MyPriority narrow network plans feature:

• No referral needed to see an in-network specialist

• Provider-specific names to make it easier for you to understand which facilities are covered

• Free health coaching: One-on-one support available to help you with weight management,

tobacco cessation, diabetes care and more


OTSEGO

CHARLEVOIX

MONTMORENCY

ALPENA

OSCODA ALCONA

OGEMAW

ISABELLA

GLADWIN

HURON

SAGINAW

GENESEESHIAWASSEE

LAPEER

OAKLAND

MACOMB

LIVINGSTONINGHAM

VAN BUREN


MONROE


WAYNE

ST. CLAIR

SANILAC

MIDLAND

BAY

ARENAC

IOSCO

EMMET

ANTRIM

KALKASKAGRAND

TRAVERSE

LEELANAU

BENZIE CRAWFORD


LAKEMASON

OCEANA

NEWAYGO

MECOSTA

MONTCALM

KENT IONIAOTTAWA

BARRY

MUSKEGON GRATIOT

CLINTON

EATONALLEGAN

OSCEOLACLARE

TUSCOLA


OTSEGO

CHARLEVOIX

MONTMORENCY

ALPENA

OSCODA ALCONA

OGEMAW

ISABELLA

GLADWIN

HURON

SAGINAW

GENESEESHIAWASSEE

LAPEER

OAKLAND

MACOMB

LIVINGSTONINGHAM

VAN BUREN


MONROE


WAYNE

ST. CLAIR

SANILAC

MIDLAND

BAY

ARENAC

IOSCO

EMMET

ANTRIM

KALKASKAGRAND

TRAVERSE

LEELANAU

BENZIE CRAWFORD


LAKEMASON

OCEANA

NEWAYGO

MECOSTA

MONTCALM

KENT IONIAOTTAWA

BARRY

MUSKEGON GRATIOT

CLINTON

EATONALLEGAN

OSCEOLACLARE

TUSCOLA

St. John Macomb

St. John Cornerstone

Providence Hospital



OTSEGO

CHARLEVOIX

MONTMORENCY

ALPENA

OSCODA ALCONA

OGEMAW

ISABELLA

GLADWIN

HURON

SAGINAW

GENESEESHIAWASSEE

LAPEER

OAKLAND

MACOMB

LIVINGSTONINGHAM

VAN BUREN


MONROE


WAYNE

ST. CLAIR

SANILAC

MIDLAND

BAY

ARENAC

IOSCO

EMMET

ANTRIM

KALKASKAGRAND

TRAVERSE

LEELANAU

BENZIE CRAWFORD


LAKEMASON

OCEANA

NEWAYGO

MECOSTA

MONTCALM

KENT IONIAOTTAWA

BARRY

MUSKEGON GRATIOT

CLINTON

EATONALLEGAN

OSCEOLACLARE

TUSCOLA


OTSEGO

CHARLEVOIX

MONTMORENCY

ALPENA

OSCODA ALCONA

OGEMAW

ISABELLA

GLADWIN

HURON

SAGINAW

GENESEESHIAWASSEE

LAPEER

OAKLAND

MACOMB

LIVINGSTONINGHAM

VAN BUREN


MONROE


WAYNE

ST. CLAIR

SANILAC

MIDLAND

BAY

ARENAC

IOSCO

EMMET

ANTRIM

KALKASKAGRAND

TRAVERSE

LEELANAU

BENZIE CRAWFORD


LAKEMASON

OCEANA

NEWAYGO

MECOSTA

MONTCALM

KENT IONIAOTTAWA

BARRY

MUSKEGON GRATIOT

CLINTON

EATONALLEGAN

OSCEOLACLARE

TUSCOLA

These plans require members to receive care at facilities within the health system’s network of hospitals and

affiliated providers. Care received outside of the network will not be covered, and members will be required

to cover the full cost for out-of-network care.

St. Joseph Mercy Health System Network

Offered to individuals who live in Wayne, Oakland, Macomb, Washtenaw and

Livingston counties


Hospitals: St. Joseph Mercy Chelsea, St. Joseph Mercy Hospital, St. Joseph

Mercy Livingston Hospital, St. Joseph Mercy Oakland Hospital, St. Mary Mercy

Livonia Hospital


All physicians who are affiliated with St. Joseph Mercy groups as listed below:

IHA

Huron Valley Physician Association

Oakland Physician Network Services

- with St. Joseph Mercy Oakland designated as the primary hospital

Livingston Physician Organization

St. Mary Mercy Physician Practices



Plans we offer17

MyPriority HMO HSA Silver 3000 – Off-Marketplace

Offers a lower monthly premium because you purchase it directly from Priority Health

and avoid fees associated with plans offered on the federally run Marketplace

Full network option:


Narrow network options (must stay within assigned network):

MyPriority HMO HSA Silver 3000 – Off-Marketplace – Spectrum Health Partners

Available only to residents who live in Kent County

MyPriority HMO HSA Silver 3000 – Off-Marketplace – Bronson Healthcare Partners

Available only to residents who live in Kalamazoo, Van Buren and a portion of Calhoun counties*

MyPriority HMO HSA Silver 3000 – Off-Marketplace – Beaumont Health Network

Available only to residents who live in Wayne, Oakland and Macomb counties

MyPriority HMO HSA Silver 3000 – Off-Marketplace – St. John Providence Network


MyPriority HMO HSA Silver 3000 – Off-Marketplace – St. Joseph Mercy Health System Network

Available only to residents who live in Wayne, Oakland, Macomb, Washtenaw and Livingston counties

MyPriority HSA plansChoose from our affordable full and narrow network plan options

*ZIP codes in Calhoun County where the Bronson Healthcare Partners narrow network is offered: 49011, 49014, 49015, 49017, 49021, 49029, 49033, 49037, 49051, 49052, 49068, 49076, 49092, 4909418


Deductible: Individual / family $3,000 / $6,000

Out-of-pocket limit: Individual / family $6,750 / $13,500

Coinsurance You pay: 30% coinsurance after deductible

Office visits: Primary doctor

You pay: 30% coinsurance after deductibleOffice visits: Urgent care

Office visits: Specialist

Office visits: Mental health

Virtual visits

24/7 access to a doctor via phone or onlineYou pay: 0% coinsurance after deductible

Prescription drug coverage (A drug is categorized in one of the tiers below.)

Preferred generic drugs

You pay: 30% coinsurance after deductible

Generic drugs

Preferred brand-name drugs

Non-preferred brand-name drugs

Specialty drug

MaternityRoutine prenatal and postnatal care covered in full,

deductible does not apply

Inpatient hospital care

(includes labor and delivery)You pay: 30% coinsurance after deductible

Outpatient surgery You pay: 30% coinsurance after deductible

Diagnostic tests, X-rays,

lab services and radiology servicesYou pay: 30% coinsurance after deductible

Emergency services 30% coinsurance after deductible

Preventive services

(including annual physical exam)

Covered in full. Deductible does not apply.

See Preventive Care Guidelines on priorityhealth.com

for more details.

Physical and occupational therapy

(including chiropractic)

30 combined visits per year with 30% coinsurance

after deductible

In-home hospice, in-home health care You pay: 30% coinsurance after deductible

Visit mypriority.com to learn more about the plans we offer.

*MyPriority narrow network details explained on pages 12–15.






MyPriority HMO HSA Bronze 6750 – Spectrum Health Partners


MyPriority HMO HSA Bronze 6750 – Bronson Healthcare Partners


MyPriority HMO HSA Bronze 6750 – Beaumont Health Network


MyPriority HMO HSA Bronze 6750 – St. John Providence Network


MyPriority HMO HSA Bronze 6750 – St. Joseph Mercy Health System Network



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Deductible: Individual / family$6,750 / $13,500

Out-of-pocket limit: Individual / family


Office visits: Primary doctor

You pay: 0% coinsurance after deductibleOffice visits: Urgent care

Office visits: Specialist

Office visits: Mental health

Virtual visits

24/7 access to a doctor via phone or onlineYou pay: 0% coinsurance after deductible


Preferred generic drugs


Generic drugs

Preferred brand-name drugs

Non-preferred brand-name drugs

Specialty drug

Maternity Routine prenatal and postnatal care covered in full

Inpatient hospital care

(includes labor and delivery)You pay: 0% coinsurance after deductible

Outpatient surgery You pay: 0% coinsurance after deductible

Diagnostic tests, X-rays,

lab services and radiology servicesYou pay: 0% coinsurance after deductible

Emergency services You pay: 0% coinsurance after deductible

Preventive services

(including annual physical exam)


See Preventive Care Guidelines on priorityhealth.com

for more details.

Physical and occupational therapy

(including chiropractic)

30 combined visits per year with 0% coinsurance

after deductible


Visit mypriority.com to learn more about the plans we offer.



MyPriority HMO plansChoose from our affordable full and narrow network plan options

MyPriority HMO Silver 3200 – Off-Marketplace

Offers a lower monthly premium because you purchase it directly from Priority Health

and avoid fees associated with plans offered on the federally run Marketplace




MyPriority HMO Silver 3200 – Off-Marketplace – Spectrum Health Partners


MyPriority HMO Silver 3200 – Off-Marketplace – Bronson Healthcare Partners


MyPriority HMO Silver 3200 – Off-Marketplace – Beaumont Health Network


MyPriority HMO Silver 3200 – Off-Marketplace – St. John Providence Network


MyPriority HMO Silver 3200 – Off-Marketplace – St. Joseph Mercy Health System Network



232019 CONSUMER PRODUCT GUIDEVisit mypriority.com to learn more about the plans we offer.





Office visits: Primary doctor $30 copay; unlimited office visits (evaluation only), before deductible

Office visits: Urgent care $75 copay; unlimited office visits (evaluation only), before deductible

Office visits: Specialist $45 copay; office visits (evaluation only), after deductible

Office visits: Mental health $30 copay; unlimited office visits only, before deductible

Virtual visits24/7 access to a doctor via phone or online

Unlimited visits; covered in full

Prescription drug coverage (A drug is categorized in one of the tiers below.) Our HMO Silver 3200 – Off-Marketplace plan has a different approved drug list. Want to find out if your prescription drug is covered? Visit priorityhealth.com and click on approved drug list.

Preferred generic drugs $5 copay before deductible

Generic drugs $20 copay before deductible

Preferred brand-name drugs $75 copay after deductible

Non-preferred brand-name drugs $100 copay after deductible

Specialty drug You pay: 50% coinsurance after deductible


Inpatient hospital care(includes labor and delivery)

$500 copayment per day (up to 10 days) plus 30% coinsurance after deductible

Outpatient surgery $1,000 copayment plus 30% coinsurance after deductible

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


Emergency services$250 copayment (waived if admitted) plus 30% coinsurance after deductible

Preventive services(including annual physical exam)


See Preventive Care Guidelines on priorityhealth.com for more details.

Physical and occupational therapy(including chiropractic)

30 combined visits per year with 30% coinsurance after deductible







MyPriority HMO Silver 3200 – Spectrum Health Partners


MyPriority HMO Silver 3200 – Bronson Healthcare Partners


MyPriority HMO Silver 3200 – Beaumont Health Network


MyPriority HMO Silver 3200 – St. John Providence Network


MyPriority HMO Silver 3200 – St. Joseph Mercy Health System Network



24

252019 CONSUMER PRODUCT GUIDEVisit mypriority.com to learn more about the plans we offer.





Office visits: Primary doctor $30 copay; unlimited office visits (evaluation only), before deductible

Office visits: Urgent care $75 copay; unlimited office visits (evaluation only), before deductible

Office visits: Specialist $45 copay; office visits (evaluation only), after deductible

Office visits: Mental health $30 copay; unlimited office visits only, before deductible

Virtual visits24/7 access to a doctor via phone or online

Unlimited visits; covered in full


Preferred generic drugs $5 copay before deductible

Generic drugs $20 copay before deductible

Preferred brand-name drugs $75 copay after deductible

Non-preferred brand-name drugs $100 copay after deductible

Specialty drug You pay: 50% coinsurance after deductible


Inpatient hospital care(includes labor and delivery)

$500 copayment per day (up to 10 days) plus 30% coinsurance after deductible

Outpatient surgery $1,000 copayment plus 30% coinsurance after deductible

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


Emergency services$250 copayment (waived if admitted) plus 30% coinsurance after deductible

Preventive services(including annual physical exam)


See Preventive Care Guidelines on priorityhealth.com for more details.

Physical and occupational therapy(including chiropractic)

30 combined visits per year with 30% coinsurance after deductible



MyPriority Delta Dental Standard and EnhancedWe’ve partnered with Delta Dental to offer affordable dental coverage that includes the nation’s largest dental networks.

26


Benefits

MyPriority

Delta Dental –

Standard

MyPriority

Delta Dental –

Enhanced

Premiums You pay You pay

Supplemental dental added to any plan $29.36 $39.93

Deductibles You pay You pay

Annual deductible$50 per person on the plan, $150 per family

None

Benefits You pay You pay

Exams, cleanings (limit two per year) 0% 0%

Fluoride treatments (up to age 14 and limit one per year) 0% 0%

Emergency treatment to temporarily relieve pain 20% 20%

X-rays (limit one per 24 months) 20% 20%

Sealants to prevent decay of permanent molars (to age nine on first molars and age 14 on second molars, limit one per lifetime)

20% 20%

Oral surgery services, extractions and dental surgeryIncludes preoperative and postoperative care

50% after deductible* 25%**

Minor restorative services (like fillings) to repair teeth damaged by disease or injury 50% after deductible* 25%**

Endodontics (like root canals) to treat teeth with diseased or damaged nerves 50% after deductible 50%**

Periodontics – used to treat diseases of the gums and supporting structures of the teeth 50% after deductible* 50%**

Bridges, dentures, implants, crowns 50% after deductible* 50%**

Orthodontic diagnostic procedures (to age 19), $1,500 per person per lifetime Not covered 50%**

Annual benefit maximum*

*Maximums apply per individual for preventive, basic and major dental treatment. Maximums for orthodontic services are calculated separately.

$1,000 per person on the plan

$1,500 per person on the plan

* There is a 12 month waiting period on Oral Surgery, Minor Restorative, Periodontics, Endodontics, Relines & Repairs, Other Basic, Major Restorative, Prosthodontic, and Implant Services. Waiting periods can be waived for all services if the enrollee was covered at least 12 months under an immediately preceding dental plan. **There is a 6 month waiting period on Oral Surgery, Minor Restorative, Periodontics, Endodontics, Relines & Repairs, Other Basic, Major Restorative, Prosthodontic, Implant, and Orthodontic Services. Waiting periods can be waived for all services if the enrollee was covered at least 12 months under an immediately preceding dental plan.

2019 CONSUMER PRODUCT GUIDE 29

What plan is right for me?Need help differentiating between health insurance plans? Here are a few examples of situations to help you choose the plan that's best for you.

30

“I want an insurance company that treats me like a person.”

Her storyMarried with two children, Melinda maintains a tight budget in order to save for college expenses and raise

a family. Her family doesn’t qualify for a federal subsidy, and she is comparison shopping for a plan with a

lower monthly premium and routine care for a lower copay. She has her pre-diabetes under control, but

wants to be able to see her primary doctor for a reasonable copay. Her husband is a low utilizer, but he

also wants a convenient and affordable way to get care for common illnesses, especially for their kids.

Products to considerMyPriority HMO Silver 3200 – Off-Marketplace (full and narrow network options)

Why?With free unlimited virtual visits, unlimited $30 primary doctor visits and $5 preferred generic prescriptions

before deductible, this plan is a great option for Melinda and her family. Because her family does not

qualify for a federal subsidy, she can purchase this plan directly from Priority Health and avoid fees

associated with plans offered on the federally run Marketplace.

Melinda, Age 42

Looking to switch plans


“It’s important to keep my family healthy and save money so we can spend it on the things that make us happy.”

His storyRick is a hardworking, married father of three. He and his wife married later in life after nurturing their

successful careers. Rick rarely visits the doctor except for an annual flu shot or if he has a bad sinus

infection. He recently discovered he has pre-diabetes, so he now monitors his health. He doesn’t want

to pay too much out of pocket for care and only wants coverage for the unexpected.

Products to considerMyPriority HMO HSA Silver 3000 – Off-Marketplace (full and narrow network options)

Why?The HSA health plan is an affordable choice if you’re generally healthy, savings-minded and want a plan

that is paired with the advantages of a health savings account (HSA). An HSA will help pay for medical

expenses and is eligible for federal tax advantages. Any unused money automatically rolls over from year

to year. Because his family does not qualify for a federal subsidy, he can purchase this plan directly from

Priority Health and avoid fees associated with plans offered on the federally run Marketplace.

Rick, Age 48

Wants coverage for the unexpected

The strength of our network

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OTSEGO

CHARLEVOIX

MONTMORENCY ALPENA

OSCODA ALCONA

OGEMAW

CLARE

ISABELLA

GLADWIN

HURON

TUSCOLA

SAGINAW

GENESEE

SHIAWASSEE

LAPEER

OAKLAND

MACOMB

LIVINGSTONINGHAM

VAN BUREN

BERRIEN CASS ST. JOSEPH BRANCH HILLSDALE LENAWEEMONROE

KALAMAZOO CALHOUN JACKSON WASHTENAW WAYNE

ST. CLAIR

SANILAC

MIDLAND

BAY

ARENAC

IOSCO

EMMET

ANTRIM

KALKASKAGRAND

TRAVERSE

LEELANAU

BENZIE CRAWFORD


OSCEOLALAKEMASON

OCEANA

NEWAYGO

MECOSTA

MONTCALM

KENT IONIAOTTAWA

ALLEGAN BARRY

MUSKEGON GRATIOT

CLINTON

EATON

MENOMINEE

DELTAMACKINAC

DICKINSON

IRON SCHOOLCRAFT

ALGER

LUCE

GOGEBIC

CHIPPEWA

MARQUETTE

BARAGAONTONAGON

HOUGHTON

KEWEENAW

Service area HMO plans

Priority Health broad network service area

Includes nationwide dependent and

emergency coverage for members who

travel outside the state of Michigan

through the Cigna PPO Network*

*Cigna's PPO network refers to the health care providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration. Cigna performs Utilization Management for any care delivered by a Cigna provider. Priority Health is an independent company and not an affiliate of Cigna. Any Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company. The Cigna name and other Cigna marks are owned by Cigna Intellectual Property, Inc.

Our network of health care providers covers 97% of doctors and hospitals in Michigan

34

At over 97%, we have the highest percent of access to providers and hospitals in Michigan. For the most current list of

participating hospitals, physicians, pharmacies and labs, visit priorityhealth.com and click on Find a Doctor.

Participating hospitals

Allegan General Hospital

Karmanos Cancer Center (Barbara Ann Karmanos Cancer Institute)

Beaumont Hospital - Dearborn

Beaumont Hospital - Farmington Hills

Beaumont Hospital - Grosse Pointe

Beaumont Hospital - Royal Oak

Beaumont Hospital - Taylor

Beaumont Hospital - Trenton

Beaumont Hospital - Troy

Beaumont Hospital - Wayne

Bixby Medical Center

Borgess Lee Memorial Hospital

Borgess Medical Center

Bronson Battle Creek Hospital

Bronson Lakeview Hospital

Bronson Methodist Hospital

Bronson South Haven Hospital

Caro Community Hospital

Children's Hospital Of Michigan (DMC)

Community Health Center Of Branch County

Community Hospital (Lakeland Community Hospital - Watervliet)

Covenant Healthcare

Crittenton Hospital Medical Center

Deckerville Community Hospital

Eaton Rapids Medical Center

Flower Hospital

Forest Health Medical Center

Genesys Regional Medical Center

Harbor Beach Community Hospital

Harper University Hospital (DMC)

Hayes Green Beach Memorial Hospital

Henry Ford Allegiance Health

Henry Ford Hospital

Henry Ford Macomb Hospital

Henry Ford West Bloomfield Hospital

Henry Ford Wyandotte Hospital

Herrick Medical Center

Hills And Dales General Hospital

Hillsdale Community Hospital

Holland Hospital

Hurley Medical Center

Huron Medical Center

Huron Valley-Sinai Hospital (DMC)

Kalkaska Memorial Health Center

Lake Huron Medical Center

Lakeland Community Hospital - Niles

Lakeland Regional Health System

Lakeland Specialty Hospital

Mackinac Straits Hospital and Health Center

Marlette Regional Hospital

Mckenzie Memorial Hospital

McLaren Bay Region

McLaren Central Michigan

McLaren Flint

McLaren Greater Lansing

McLaren Greater Lansing Orthopedic

McLaren Lapeer Region

McLaren Macomb

McLaren Northern Michigan

McLaren Oakland

McLaren Port Huron

Memorial Healthcare


Mercy Health Muskegon - General Campus

Mercy Health Muskegon - Hackley Campus

Mercy Health Muskegon - Mercy Campus

Mercy Health - Saint Mary’s

Metro Health Hospital

Mhp Lakeshore Campus

Midmichigan Medical Center - Alpena

Midmichigan Medical Center - Clare

Midmichigan Medical Center - Gladwin

Midmichigan Medical Center - Gratiot

Midmichigan Medical Center - Midland

Munson Healthcare Cadillac Hospital

Munson Healthcare Charlevoix Hospital

Munson Healthcare Grayling Hospital

Munson Healthcare Manistee Hospital

Munson Medical Center

North Ottawa Community Hospital

Oakland Regional Hospital

Oaklawn Hospital

Otsego Memorial Hospital

Paul Oliver Memorial Hospital

Pontiac General Hospital

Promedica Monroe Regional Hospital

Providence Park Hospital - Novi Campus

Providence Park Hospital - Southfield Campus

Scheurer Hospital

Sheridan Community Hospital

Sinai-Grace Hospital (DMC)

Sparrow Carson Hospital

Sparrow Ionia Hospital

Spectrum Health Big Rapids Hospital

Spectrum Health Blodgett Hospital

Spectrum Health Butterworth Hospital

Spectrum Health Gerber Memorial

Spectrum Health Kelsey Hospital

Spectrum Health Ludington Hospital

Spectrum Health Pennock

Spectrum Health Reed City Hospital

Spectrum Health United Memorial

Spectrum Health Zeeland Community Hospital

St Joseph Health Systems

St. John Hospital And Medical Center

St. John Macomb-Oakland Hospital - Macomb Center

St. John Macomb-Oakland Hospital - Oakland Center

St. John River District Hospital

St. Joseph Mercy Chelsea

St. Joseph Mercy Hospital

St. Joseph Mercy Livingston Hospital

St. Joseph Mercy Oakland

St. Mary Mercy Hospital Livonia

St. Mary's Of Michigan

St. Mary's Of Michigan Standish Hospital

Straith Hospital For Special Surgery

Sturgis Hospital

Tawas St. Joseph Health System

The Toledo Hospital

Three Rivers Health

Detroit Medical Center-DMC (VHS Detroit Receiving Hospital)

West Branch Regional Medical Center

36

Know the cost before the care

With Cost Estimator, you can compare prices of procedures and prescriptions

before you receive them, which saves you money. Plus, when you choose a

lower-cost, high-quality facility for care, we'll send you a Visa rewards card

through our PriorityRewards program.

Learn more at priorityhealth.com/estimate-my-costs.

Take control of your health

Whether you’re managing a health condition, want financial advice or just looking for ways

to destress, the Wellbeing Hub can help. Information and tools offered are tailored to each

member’s specific interests and health needs. Become empowered to be happier and healthier

while improving your overall wellbeing.

Learn more at priorityhealth.com/wellbeing-hub.

24/7 access to a doctor

Your busy family needs the doctor to be in on your schedule. That’s why our plans come with

virtual care for routine illnesses. Get access to care wherever you are, 24 hours a day, 7 days a

week. Virtual care usually costs less than an emergency room visit. You just need internet access

and an internet-ready device.

Learn more at priorityhealth.com/call-or-click.

Why choose Priority Health?

PriorityRewards is not available for MyPriority Individual members enrolled in a narrow network plan.


Break a sweat without breaking the bank

Ready to get moving? It’s easier than ever with the Active&Fit Direct program, which allows

you to choose from 9,000+ participating fitness centers nationwide for $25 a month (plus a

$25 enrollment fee).

Learn more at priorityhealth.com/activeandfit.

Save time and money and never miss a payment

Automatic Bill Pay is the stress-free way to pay your bill on time every month. Ditch the paper

and sign up for easy automatic bill pay. You can sign up for automatic monthly bank account

withdrawals or pay anytime by check or over the phone.

Travel with confidence

Planning a trip? See the world knowing you’re covered for emergency and urgent care. Our

partner Assist America® provides global emergency medical services for members. If you

become ill or injured while traveling more than 100 miles from home or while in a foreign

country, Assist America provides support with medical referrals, monitoring, evacuation,

repatriation and much more.

Learn more at priorityhealth.com/assist-america.

As a Priority Health member, you get access to innovative tools and programs that help you save money, get healthier, be happier and live better.

38

Notes

40 ©2018 Priority Health PH764 10172B 08/18

Visit mypriority.com

Call our enrollment specialists at 833.514.11068:00 a.m. – 8 p.m., Monday – Friday

9:00 a.m. – 1 p.m., Saturday and Sunday

get health insurance plans & quotes - 2019 choose mypriority...you get the most out of your...

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