MyPriority Balanced Silver – HMO

Description

This plan has 94% cost sharing reduction [Popular Plan]

Health Care Plan Details

Network type	HMO
Deductible	$350 per person $350 per person
Out-of-pocket max	$950 per person $1,900 per family
Metal tier	Silver

Visit Copay

Primary care visit	$5 copay
Specialist visit	$10 copay
Preventive care visit	No charge

Urgent, Emergency Care, and Hospital Care

Urgent care	$75 copay
Emergency room	10% coinsurance after deductible
Ambulance	10% coinsurance after deductible
Hospital stay (facility)	10% coinsurance after deductible
Hospital stay (physician)	10% coinsurance after deductible
Outpatient procedure (facility)	$1000 copay after deductible, 10% coinsurance after deductible
Outpatient procedure (physician)	10% coinsurance after deductible
Physical rehabilitation	10% coinsurance after deductible

Maternitowny and Pregnancy

Well baby care	No charge
Labor, delivery, hospital stay	10% coinsurance after deductible

Pharmacy, Drugs, and Medication

Generic	$5 copay
Brand	$15 copay after deductible
Non-preferred Brand	$25 copay after deductible
Specialty	50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays	10% coinsurance after deductible
Imaging (CT/PET/MRI)	10% coinsurance after deductible
Blood work	No charge

Mental and Psychiatric Health Care

Mental Health outpatient services	$5 copay
Psychiatric hospital stay	10% coinsurance after deductible

Health Plan Provider Information

Health Plan Benefits	https://www.priorityhealth.com/-/media/7CCD75F576924C01B56A28FB94D7CBF4.pdf
Drug and medication plan formulary	https://www.priorityhealth.com/formulary
Search doctor list	https://web.healthsparq.com/healthsparq/public/#/one/insurerCode=PH_I&brandCode=PH