mypriority - health insurance software for...
TRANSCRIPT
Individual & family health insurance plans
MyPrioritySM
2 For more information call 855.MyPriority (855.697.7467)
3priorityhealth.com
Just right for you Choosing the right health insurance is an important decision. With several plans to choose from, an accident rider and dental options, you can have coverage that’s geared to your lifestyle and budget. Priority Health makes it easy, with health insurance designed especially for you.
How MyPriority works for you
MyPriority PPO Before you meet your deductible
• Preventivehealthvisitsandproceduresarecoveredinfull*
• You’llpayjust$30everytimeyouseeadoctororgotourgentcare
(up to four visits per year)
• Twooptionsforprescriptiondrugcoverage
-We’llcover60%ofbrandorgenericor50%ofgenericsonly
• Yourcostswilltracktoseparatedeductiblesforin-network
andout-of-networkcare*
Once you meet your deductible
You’llpayjustaportionofthediscountedcostofcoveredservices.The
percentagedependsonwhichplanyouselect.*
Accident rider (optional coverage)
Wewaivethedeductible,andyoupayonly20%or30%forcoveredservices
within60daysoftheaccident(dependingontheoptionyouchoose).
Start by choosing a PPO or HSA plan.*
* For full details on PPO options and rates see page 6 and page 12.
MyPriority HSA • MakedepositstoyourHSAatanytime
• Benefitfromtax-deferredinvestmentaccount
• Withdrawthecashtax-free—noworlater—forqualified
medicalexpenses
• Saveaheadforfuturemedicalexpenseswithno“useitor
lose it” rules
Before you meet your deductible
• Preventivehealthvisitsandproceduresare100%covered*
• You’llpayforyourprescriptionsandotherhealthservicesusing
fundsfromyourtax-advantagedhealthsavingsaccount
• You’lltakeadvantageofourin-networkdiscountsonprescriptions
and other health services
Once you meet your deductible
In-networkservicesandprescriptionsarecovered100%,andyou’llhave50%
coverage for most out-of-network services.
Accident rider (optional coverage)
Wecoverthefirst$1,000forallcoveredserviceswithin60daysoftheaccident.
Get your free copy of
our e-book, Health
Savings Accounts for
Dummies. It’s full of easy-
to-understand facts about
HSAs. Download your copy
online at priorityhealth.com,
keyword search HSA.
Get Answers
Apply todayIt’seasytoenjoytheaffordablesecurityofMyPriority. Just pick your plan and complete the application. To learn more:
•Getaninstantquoteatpriorityhealth.com
•Callusformoreinformationtoll-freeat855.MyPriority(855.697.7467)
•Contactyourlocalagent
* For full details on HSA options and rates see pages 8 and 16.
6 For more information call 855.MyPriority (855.697.7467)
Ann
ual d
educ
tible
–
sing
le
in-n
etw
ork1
–
fam
ily
$1,0
00
$2,0
00
$2,5
00
$5,0
00
$3,5
00
$7,0
00
$5,0
00
$10,
000
$7,5
00
$15,
000
$10,
000
$2
0,00
0$1
,000
$2
,000
$2,5
00
$5,0
00$1
,000
$2
,000
$3,0
00
$6,0
00
Ann
ual d
educ
tible
–
sing
le
out-
of-n
etw
ork
– fa
mily
$2,0
00
$4,0
00
$5,0
00
$10,
000
$7,0
00
$14,
000
$1
0,00
0
$20,
000
$15,
000
$3
0,00
0$2
0,00
0
$40,
000
$2,0
00
$4,0
00$5
,000
$1
0,00
0$2
,000
$4
,000
$6,0
00
$12,
000
Coi
nsur
ance
– P
lan
Pay
s:(u
nles
s ot
herw
ise
note
d)
• 8
0% in
-net
wor
k•
60%
out
-of-
netw
ork
• 7
0% in
-net
wor
k•
50%
out
-of-
netw
ork
• 7
0% in
-net
wor
k•
50%
out
-of-
netw
ork
Ann
ual i
n-ne
twor
k
– si
ngle
ou
t-of
-poc
ket
max
imum
2 –
fam
ily$3
,000
$6
,000
$4
,500
$9
,000
$5
,500
$1
1,00
0$7
,000
$1
4,00
0$9
,500
$1
9,00
0$1
2,00
0
$24,
000
$4,0
00
$8,0
00$6
,500
$1
3,00
0$3
,000
$6
,000
$9,0
00
$18,
000
Ann
ual o
ut-o
f-ne
twor
k
– si
ngle
ou
t-of
-poc
ket
max
imum
2 –
fam
ily$1
0,00
0
$20,
000
$13,
000
$2
6,00
0 $1
5,00
0
$30,
000
$18,
000
$3
6,00
0 $2
3,00
0
$46,
000
$28,
000
$5
6,00
0$1
2,00
0
$24,
000
$15,
000
$3
0,00
0$1
2,00
0
$24,
000
$16,
000
$3
2,00
0
Ann
ual b
enefi
t m
axim
um(fo
r in
and
out
-of-
netw
ork
serv
ices
co
mb
ined
)
$2 m
illio
n$2
mill
ion
$2 m
illio
n
Ben
efit
Wha
t yo
u pa
y
Pre
vent
ive
care
3
• $0
; 100
% c
over
ed•
$0; 1
00%
cov
ered
•$0
;100
%c
over
ed
Doc
tor'
s of
fice
visi
ts4
• $3
0 co
pay
befo
re d
educ
tible
•$3
0co
pay
befo
red
educ
tible
•$3
0co
pay
befo
red
educ
tible
Urg
ent
care
4
Em
erge
ncy
room
5•
$150
cop
ay•
30%
coi
nsur
ance
in-n
etw
ork
afte
r de
duct
ible
• 30
% c
oins
uran
ce o
ut-o
f-ne
twor
k af
ter
dedu
ctib
le
•$1
50c
opay
•30
%c
oins
uran
cein
-net
wor
kaf
ter d
educ
tible
•30
%c
oins
uran
ceo
ut-o
f-ne
twor
k af
ter d
educ
tible
•$1
50c
opay
•
40%
in-n
etw
ork
coin
sura
nce
afte
r ded
uctib
le•
40%
out
-of-
netw
ork
coin
sura
nce
afte
r ded
uctib
le
Am
bul
ance
•
30%
coi
nsur
ance
in-n
etw
ork
afte
r de
duct
ible
• 30
% c
oins
uran
ce o
ut-o
f-ne
twor
k af
ter
dedu
ctib
le•
30%
coi
nsur
ance
in-n
etw
ork
afte
r ded
uctib
le•
30%
coi
nsur
ance
out
-of-
netw
ork
afte
r ded
uctib
le
•40
%in
-net
wor
kco
insu
ranc
eaf
ter d
educ
tible
•40
%o
ut-o
f-ne
twor
kco
insu
ranc
e af
ter d
educ
tible
Out
pat
ient
lab
/X-r
ay•
20%
coi
nsur
ance
in-n
etw
ork
afte
r de
duct
ible
• 40
% c
oins
uran
ce o
ut-o
f-ne
twor
k af
ter
dedu
ctib
le•
30%
coi
nsur
ance
in-n
etw
ork
afte
r ded
uctib
le•
50%
coi
nsur
ance
out
-of-
netw
ork
afte
r ded
uctib
le
•30
%c
oins
uran
cein
-net
wor
kaf
ter d
educ
tible
•50
%c
oins
uran
ceo
ut-o
f-ne
twor
k af
ter d
educ
tible
Out
pat
ient
sur
gery
Hos
pita
lizat
ion
Out
pat
ient
sp
eech
the
rap
y6
Out
pat
ient
occ
upat
iona
l the
rap
y6
Out
pat
ient
phy
sica
l the
rap
y/
spin
al m
anip
ulat
ion6
Car
dia
c re
hab
6
Ski
lled
nur
sing
; Sub
acut
e; In
pat
ient
re
hab
; Hos
pic
e7
Hom
e he
alth
car
e8
Sub
stan
ce a
bus
e9
Die
titia
n se
rvic
es10
80%M
edical
60%Brand
/gen
ericdrug
70%M
edical
60%Brand
/gen
ericdrug
70%M
edical
50%Genericdrugsonly
Overviewofb
enefits
MyP
rio
rity
PP
O
7priorityhealth.com
DM
E; P
&O
11•
50%
coi
nsur
ance
aft
erd
educ
tible
•
50%
coi
nsur
ance
afte
rde
duct
ible
•50
%c
oins
uran
cea
fter
dedu
ctib
le
Pre
scrip
tion
dru
g co
vera
ge12
•40
%c
opay
for
gene
rics
and
bran
ddr
ugs
befo
red
educ
tible
•In
clud
eso
ralc
ontr
acep
tives
•
40%
cop
ayfo
rgen
eric
san
dbr
and
drug
sbe
fore
de
duct
ible
•In
clud
eso
ralc
ontr
acep
tives
•G
ener
icd
rugs
cov
ered
at
50%
bef
ore
dedu
ctib
le
•In
clud
eso
ralc
ontr
acep
tives
•B
rand
sat
Prio
rity
Hea
lth
disc
ount
ed p
rice
befo
re
dedu
ctib
le
Med
ical
sp
ecia
lty d
rugs
13•
20%
coi
nsur
ance
in-n
etw
ork
afte
rde
duct
ible
•40
%c
oins
uran
ceo
ut-o
fnet
wor
kaf
ter
dedu
ctib
le•
30%
coi
nsur
ance
in-n
etw
ork
afte
r ded
uctib
le•
50%
coi
nsur
ance
out
-of-
netw
ork
af
ter d
educ
tible
•50
%c
oins
uran
cea
fter
dedu
ctib
le
Tran
spla
nts14
•A
tdes
igna
ted
tran
spla
ntfa
cilit
y•
Atd
esig
nate
dtr
ansp
lant
fa
cilit
y•
Atd
esig
nate
dtr
ansp
lant
fa
cilit
y
Op
tiona
l cov
erag
e
Acc
iden
t rid
er15
•20
%c
oins
uran
cein
-net
wor
kbe
fore
ded
uctib
le•
40%
coi
nsur
ance
out
-of-
netw
ork
befo
red
educ
tible
•30
%c
oins
uran
cein
-net
wor
k be
fore
ded
uctib
le•
50%
coi
nsur
ance
out
-of-
netw
ork
befo
re d
educ
tible
•30
%c
oins
uran
cein
-net
wor
k be
fore
ded
uctib
le•
50%
coi
nsur
ance
out
-of-
netw
ork
befo
re d
educ
tible
MyP
riorit
y D
enta
lM
yPrio
rity
Den
tal P
ro(s
ee p
age
10 fo
r de
tails
)
•N
one
twor
kre
quire
d•
Ann
uald
educ
tible
:$50
per
per
son,
$15
0pe
rfa
mily
up
toth
ree
mem
bers
•O
rtho
dont
ics
ervi
ces
Not
cov
ered
(for
all
ded
uctib
le o
ptio
ns)
•C
erta
ins
urge
ries
—b
aria
tric
sur
gery
,ble
phar
opla
sty
ofu
pper
eye
lids,
bre
astr
educ
tion,
pan
nicu
lect
omy,
sur
gica
ltre
atm
ento
f m
ale
gyne
com
astia
and
pro
cedu
res
toc
orre
cto
bstr
uctiv
esl
eep
apne
a.
•Fa
mily
pla
nnin
g/in
fert
ility
ser
vice
s—
vas
ecto
my,
tuba
lliti
gatio
n,d
iaph
ragm
,inf
ertil
ityc
ouns
elin
gan
dtr
eatm
ento
fund
erly
ing
ca
use
of in
fert
ility
•
TMJ,
por
twin
est
ains
,ort
hogn
athi
csu
rger
y
90-d
ay w
aitin
g p
erio
d (f
or a
ll d
educ
tible
op
tions
)
Sur
gerie
ssu
bjec
tto
the
90d
ayw
aitin
gpe
riod
incl
ude:
Ton
sille
ctom
y,A
deno
idec
tom
y,H
emor
rhoi
dect
omy,
Hys
tere
ctom
yan
dB
unio
nect
omy,
S
urgi
calt
reat
men
toft
hefo
llow
ing
cond
ition
sar
eal
sos
ubje
ctto
the
90d
ayw
aitin
gpe
riod:
Cys
toce
le,E
nter
ocel
e,R
ecto
cele
,Ure
thro
cele
,U
terin
eP
rola
pse,
Ingu
inal
Her
nia
(oth
erth
ans
tran
gula
ted
orin
carc
erat
ed),
Car
palT
unne
lSyn
drom
ean
dVa
ricos
eVe
ins.
Pre
-exi
stin
gco
nditi
one
xclu
sion
Ben
efits
will
be
excl
uded
fo
rea
chIl
lnes
so
rIn
jury
or
cond
itio
nno
td
iscl
ose
do
nth
eap
plic
atio
n,f
or
whi
ch,d
urin
gt
hes
ixm
ont
hp
erio
d
prio
rto
the
eff
ectiv
ed
ate,
med
ical
ad
vice
,dia
gno
sis,
car
eo
rtr
eatm
ent
reco
mm
end
edb
yo
rre
ceiv
edf
rom
aH
ealth
Pro
fess
iona
l.F
or
pur
po
ses
of
this
lim
itatio
n,“
trea
tmen
t”in
clud
est
heu
seo
fp
resc
riptio
nd
rug
s.
Thi
sP
re-E
xist
ing
Co
nditi
on
excl
usio
nw
illa
pp
lyu
ntil
the
end
of
the
twel
vem
ont
hp
erio
db
egin
ning
on
the
effe
ctiv
ed
ate
und
ert
hep
olic
y.
The
Pre
-Exi
stin
gC
ond
itio
nex
clus
ion
do
esn
ot
app
lyt
oa
new
bo
rnw
hob
eco
mes
aC
ove
red
Dep
end
ent
und
ert
his
Po
licy
with
in3
1d
ays
afte
rth
eb
irth.
1
Fam
ily d
educ
tible
may
be
met
col
lect
ivel
y b
y 2
or m
ore
ind
ivid
uals
in t
he fa
mily
2
Exc
lud
es c
opay
s, in
clud
es c
oins
uran
ce a
nd d
educ
tible
3
With
in P
riorit
y H
ealth
Pre
vent
ive
Hea
lth C
are
Gui
del
ines
4
4 co
mb
ined
vis
its p
er m
emb
er a
nnua
lly –
aft
er t
he 4
vis
its, c
over
ed c
harg
es
app
ly t
owar
ds
ded
uctib
le a
nd c
oins
uran
ce.
5
Cop
ay w
aive
d if
ad
mitt
ed w
ithin
24
hour
s
6
$3,0
00 c
omb
ined
ann
ual m
ax p
er m
emb
er
7
60-d
ay c
omb
ined
ann
ual m
ax p
er m
emb
er
8
60 v
isits
ann
ual m
ax p
er m
emb
er
9
Up
to
the
stat
e-m
and
ated
ben
efit
10
6 vi
sits
per
mem
ber
per
yea
r
11
$2,0
00 m
ax p
er m
emb
er e
ach
year
for
in-n
etw
ork
serv
ices
;
$2,0
00 m
ax p
er m
emb
er e
ach
year
for
out-
of-n
etw
ork
serv
ices
12
Thes
e ex
pen
ses
do
not
go t
owar
ds
your
ded
uctib
le o
r ou
t-of
-poc
ket
max
imum
.
13
$25,
000
max
imum
per
mem
ber
eac
h ye
ar fo
r se
rvic
es r
ecei
ved
out
-of-
netw
ork
14
$1,
000,
000
max
imum
15
For
serv
ices
incu
rred
with
in 6
0-d
ays
of t
he in
jury
. A
fter
the
60-
day
s
the
ded
uctib
le w
ill b
e ap
plie
d t
o an
y co
vere
d c
harg
es.
*For
com
ple
te p
lan
det
ails
go
to p
riorit
yhea
lth.c
om
Ann
ual d
educ
tible
–
sing
le
in-n
etw
ork1
–
fam
ily
$1,0
00
$2,0
00
$2,5
00
$5,0
00
$3,5
00
$7,0
00
$5,0
00
$10,
000
$7,5
00
$15,
000
$10,
000
$2
0,00
0$1
,000
$2
,000
$2,5
00
$5,0
00$1
,000
$2
,000
$3,0
00
$6,0
00
Ann
ual d
educ
tible
–
sing
le
out-
of-n
etw
ork
– fa
mily
$2,0
00
$4,0
00
$5,0
00
$10,
000
$7,0
00
$14,
000
$1
0,00
0
$20,
000
$15,
000
$3
0,00
0$2
0,00
0
$40,
000
$2,0
00
$4,0
00$5
,000
$1
0,00
0$2
,000
$4
,000
$6,0
00
$12,
000
Coi
nsur
ance
– P
lan
Pay
s:(u
nles
s ot
herw
ise
note
d)
• 8
0% in
-net
wor
k•
60%
out
-of-
netw
ork
• 7
0% in
-net
wor
k•
50%
out
-of-
netw
ork
• 7
0% in
-net
wor
k•
50%
out
-of-
netw
ork
Ann
ual i
n-ne
twor
k
– si
ngle
ou
t-of
-poc
ket
max
imum
2 –
fam
ily$3
,000
$6
,000
$4
,500
$9
,000
$5
,500
$1
1,00
0$7
,000
$1
4,00
0$9
,500
$1
9,00
0$1
2,00
0
$24,
000
$4,0
00
$8,0
00$6
,500
$1
3,00
0$3
,000
$6
,000
$9,0
00
$18,
000
Ann
ual o
ut-o
f-ne
twor
k
– si
ngle
ou
t-of
-poc
ket
max
imum
2 –
fam
ily$1
0,00
0
$20,
000
$13,
000
$2
6,00
0 $1
5,00
0
$30,
000
$18,
000
$3
6,00
0 $2
3,00
0
$46,
000
$28,
000
$5
6,00
0$1
2,00
0
$24,
000
$15,
000
$3
0,00
0$1
2,00
0
$24,
000
$16,
000
$3
2,00
0
Ann
ual b
enefi
t m
axim
um(fo
r in
and
out
-of-
netw
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10 For more information call 855.MyPriority (855.697.7467)
Overviewofbenefits
MyPriority Dental & Dental ProMyPriority Dental MyPriority Dental Pro
$26.97 perpersonpermonth
$36.41 perpersonpermonth
Deductibles and maximums
Annualdeductible $50perpersonontheplan, $150 per family
None
Annualbenefitmaximum $1,000perpersonontheplan
$1,500perpersonontheplan
Benefit category Plan paysMember pays
Plan paysMember pays
Class I — Preventive services
Includesexams,cleanings,andfluoridetreatments.(Cleanings, exams:limittwoperyearandfluoridetreatment:limitoneperyear)
100% 0% 100% 0%
Emergencypalliativetreatment—usedtotemporarilyrelievepain 80% 20% 80% 20%
X-rays(limitoneperyear) 80% 20% 80% 20%
Sealants—dentalsealantstopreventdecayofpermanentmolars (toagenineonfirstmolarsandage14onsecondmolars,limitone perlifetime).
80% 20% 80% 20%
Class II — Minor restorative services (six month waiting period)
Oralsurgeryservices—extractionsanddentalsurgery,includingpreoperative and postoperative care
50% afterdeductible
50% 75% 25%
Minorrestorativeservices—usedtorepairteethdamagedbydiseaseorinjury(forexample,amalgam[silver]fillings)
50% afterdeductible
50% 75% 25%
Class III — Major restorative services (six month waiting period)
Endodontics—usedtotreatteethwithdiseasedordamaged nerves(rootcanalsforexample)
50% afterdeductible
50% 50% 50%
Periodontics—usedtotreatdiseasesofthegumsandsupportingstructuresoftheteeth.
50% afterdeductible
50% 50% 50%
Bridges 50% afterdeductible
50% 50% 50%
Dentures 50% afterdeductible
50% 50% 50%
Implants 50% afterdeductible
50% 50% 50%
Crowns 50% afterdeductible
50% 50% 50%
Class IV — Orthodontic services
Orthodonticdiagnosticproceduresandtreatments(toage19) 0% 0% 50% 50%
Orthodonticservicesbenefitmaximum $0–noseparatebenefitmaximumfororthodonticservices
$1,500 per person per lifetime
Additional limitations may apply for certain services.
11priorityhealth.com
6 insurance terms you should know Before,thetrivialdetailsofinsurancedidn’tmatter. Now you need to know. We make it easy.
1. Copayment: Theamountyoupayforspecificmedicalservicesandprescriptions
covered by the plan.
2. Coinsurance: ThecostoftreatmentsharedbetweenyouandPriorityHealth.
Thisisusuallycalculatedasapercentageofthetotalcost.Oftencoinsurance
applies only after you meet your deductible.
3. Coverage: With MyPriority, you’recovered.Your“coverage”iswhatwe’llpayfor.
4. Deductible:TheamountyoupayperplanyearbeforePriorityHealthstartspaying.
5. In-network: MyPriority has doctors, hospitals, pharmacies and other care
providersthatchargePriorityHealthmembersaspecialdiscountedrate.You’ll
save, too, if you use our network.
6. Urgent care: If you can’t see your regular doctor, urgent care centers and walk-in
centersareusuallyyourbestchoice.(You’llpay$30foreachvisituptofourvisits.)
Save money
You’ll save on monthly premiums if you choose higher deductibles.
12 For more information call 855.MyPriority (855.697.7467)
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98.0
01
71.0
01
28.0
01
12.0
02
65.0
02
04.0
02
21.0
01
58.0
0
45-4
9 3
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60.0
02
31.0
02
00.0
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50.0
01
31.0
03
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39.0
02
58.0
01
85.0
0
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79.0
02
98.0
02
65.0
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29.0
01
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50.0
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55.0
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74.0
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97.0
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10.0
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68.0
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01.0
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76.0
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03
21.0
03
47.0
02
49.0
0
60-6
4 5
21.0
04
10.0
03
65.0
03
16.0
02
37.0
02
07.0
04
89.0
03
77.0
04
08.0
02
93.0
0
Acc
iden
t ri
der
$4.
40
$8.
80
$11
.00
$15
.40
$17
.60
$19
.80
$4.
40
$8.
80
$4.
40
$8.
80
MyP
rio
rity
Den
tal
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
MyP
rio
rity
Den
tal P
ro$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41
70%M
edical
60%Brand
/gen
ericdrug
70%M
edical
50%Genericdrugsonly
Pre
ferr
ed p
rem
ium
s
MyP
rio
rity
PP
O
* W
hen
you
age
into
the
next
age
bra
cket
, you
r pr
emiu
ms
will
be a
djus
ted
at y
our
annu
al r
enew
al.
* If
you
mov
e to
a c
ount
y th
at is
in a
diff
eren
t pre
miu
m ta
ble,
you
r pr
emiu
ms
will
be a
djus
ted
on th
e ne
xt b
illing
cyc
le a
fter
you
have
not
ified
us
of y
our
addr
ess
chan
ge.
80%M
edical
60%Brand
/gen
ericdrug
Co
unti
es:K
alam
azoo
,Len
awee
,Liv
ings
ton,
Mac
omb
,Mon
roe,
Oak
land
,St.
Cla
ir,W
asht
enaw
,W
ayne
13priorityhealth.com
Ded
uctib
les
–S
ingl
e(in
-net
wor
k)
–Fa
mily
$1,0
00
$2,0
00$2
,500
$5
,000
$3,5
00
$7,0
00$5
,000
$1
0,00
0$7
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$1
5,00
0$1
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0$1
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$2
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00
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00$1
,000
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,000
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00$6
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Co
insu
ranc
e –
in-n
etw
ork
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out-o
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k80
%
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%
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80
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%
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60%
80
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%
70%
50
%
70%
50
%
70%
50
%
70%
50
%
Fem
ale
0-25
dep
end
ents
$10
7.00
$
85.0
0$
75.0
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65.0
0$
49.0
0$
43.0
0$
101.
00
$78
.00
$93
.00
$67
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110
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44.
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103
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24.0
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27.0
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Acc
iden
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der
$4.
40
$8.
80
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60
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Den
tal
$26.
97$2
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97$2
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MyP
rio
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Den
tal P
ro$3
6.41
$36.
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6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41
Fem
ale
0-25
dep
end
ents
$10
7.00
$
85.0
0$
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0$
65.0
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101.
00
$78
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1
09.0
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4.00
1
01.0
07
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9 1
43.0
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12.0
01
00.0
08
7.00
6
5.00
5
7.00
1
34.0
01
03.0
01
18.0
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4.00
30-3
4 1
72.0
01
36.0
01
21.0
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04.0
07
8.00
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1
62.0
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27.0
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79.0
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59.0
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38.0
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03.0
09
0.00
2
13.0
01
64.0
01
78.0
01
28.0
0
40-4
4 2
69.0
02
12.0
01
89.0
01
63.0
01
22.0
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07.0
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53.0
01
95.0
02
11.0
01
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0
45-4
9 3
15.0
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48.0
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21.0
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91.0
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95.0
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77.0
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62.0
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85.0
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53.0
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19.0
01
64.0
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44.0
03
39.0
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62.0
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83.0
02
03.0
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55-5
9 4
23.0
03
33.0
02
96.0
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56.0
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92.0
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68.0
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96.0
03
06.0
03
31.0
02
37.0
0
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98.0
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92.0
03
48.0
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26.0
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98.0
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67.0
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60.0
03
90.0
02
79.0
0
Acc
iden
t ri
der
$4.
40
$8.
80
$11
.00
$15
.40
$17
.60
$19
.80
$4.
40
$8.
80
$4.
40
$8.
80
MyP
rio
rity
Den
tal
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
MyP
rio
rity
Den
tal P
ro$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41
Pre
ferr
ed p
rem
ium
s
MyP
rio
rity
PP
O
* W
hen
you
age
into
the
next
age
bra
cket
, you
r pr
emiu
ms
will
be a
djus
ted
at y
our
annu
al r
enew
al.
* If
you
mov
e to
a c
ount
y th
at is
in a
diff
eren
t pre
miu
m ta
ble,
you
r pr
emiu
ms
will
be a
djus
ted
on th
e ne
xt b
illing
cyc
le a
fter
you
have
not
ified
us
of y
our
addr
ess
chan
ge.
Co
unti
es:J
acks
on,H
illsd
ale
80%M
edical
60%Brand
/gen
ericdrug
70%M
edical
60%Brand
/gen
ericdrug
70%M
edical
50
%Genericdrugsonly
14 For more information call 855.MyPriority (855.697.7467)
Co
unti
es:A
llega
n,A
rena
c,B
arry
,Bay
,Ber
rien,
Bra
nch,
Cal
houn
,Cas
s,C
lare
,Clin
ton,
E
aton
,Gen
esee
,Gla
dw
in,G
ratio
t,H
uron
,Ing
ham
,Ion
ia,I
sab
ella
,Ken
t,L
ake,
Lap
eer,
Mas
on,M
ecos
ta,M
idla
nd,M
ontc
alm
,Mus
kego
n,N
eway
go,O
cean
a,O
ceol
a,O
ttaw
a,
Sag
inaw
,St.
Jos
eph,
San
ilac,
Shi
awas
ee,T
usco
la,V
anB
uren
Ded
uctib
les
–S
ingl
e(in
-net
wor
k)
–Fa
mily
$1,0
00
$2,0
00$2
,500
$5
,000
$3,5
00
$7,0
00$5
,000
$1
0,00
0$7
,500
$1
5,00
0$1
0,00
0 $2
0,00
0$1
,000
$2
,000
$2,5
00
$5,0
00$1
,000
$2
,000
$3,0
00$6
,000
Co
insu
ranc
e –
in-n
etw
ork
–
out-o
f-net
wor
k80
%
60%
80
%
60%
80
%
60%
80
%60
%
80%
60%
80
%60
%
70%
50
%
70%
50
%
70%
50
%
70%
50
%
Mal
e
0-25
dep
end
ents
$10
3.00
$
81.0
0$
72.0
0$
62.0
0$
47.0
0$
41.0
0$
96.0
0$
74.0
0$
89.0
0$
64.0
0
0-18
105
.00
83.
00
74.
00
64.
00
48.
00
42.
00
99.
00
76.
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92.
00
66.
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19-2
4 1
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4.00
1
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9 1
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8
8.00
7
6.00
5
7.00
5
0.00
1
18.0
09
1.00
1
03.0
07
4.00
30-3
4 1
43.0
01
13.0
01
00.0
08
7.00
6
5.00
5
7.00
1
34.0
01
04.0
01
12.0
08
0.00
35-3
9 1
69.0
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33.0
01
19.0
01
03.0
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7.00
6
7.00
1
59.0
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23.0
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33.0
09
5.00
40-4
4 1
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54.0
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1
84.0
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42.0
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9 2
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90.0
01
69.0
01
46.0
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10.0
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6.00
2
26.0
01
75.0
01
89.0
01
36.0
0
50-5
4 3
06.0
02
41.0
02
14.0
01
85.0
01
39.0
01
22.0
02
87.0
02
22.0
02
40.0
01
72.0
0
55-5
9 3
78.0
02
98.0
02
65.0
02
29.0
01
72.0
01
50.0
03
55.0
02
74.0
02
96.0
02
12.0
0
60-6
44
62.0
03
64.0
03
24.0
02
80.0
02
10.0
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84.0
04
34.0
03
35.0
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62.0
02
60.0
0
Acc
iden
t ri
der
$4.
40
$8.
80
$8.
80
$11
.00
$13
.20
$15
.40
$4.
40
$6.
60
$4.
40
$6.
60
MyP
rio
rity
Den
tal
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
MyP
rio
rity
Den
tal P
ro$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41
Fem
ale
0-25
dep
end
ents
$10
3.00
$
81.0
0$
72.0
0$
62.0
0$
47.0
0$
41.0
0$
96.0
0$
74.0
0$
89.0
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64.0
0
0-18
105
.00
83.
00
74.
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64.
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48.
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42.
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99.
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76.
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19-2
4 1
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6
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5
1.00
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4.00
1
04.0
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9
7.00
6
9.00
25-2
9 1
37.0
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6.00
8
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1
28.0
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1
13.0
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30-3
4 1
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00.0
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57.0
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58.0
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81.0
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17.0
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42.0
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87.0
02
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45-4
9 3
01.0
02
37.0
02
11.0
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83.0
01
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20.0
02
83.0
02
18.0
02
36.0
01
69.0
0
50-5
4 3
46.0
02
72.0
02
42.0
02
10.0
01
57.0
01
37.0
03
24.0
02
51.0
02
71.0
01
94.0
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55-5
9 4
05.0
03
19.0
02
83.0
02
45.0
01
84.0
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61.0
03
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02
93.0
03
17.0
02
27.0
0
60-6
4 4
76.0
03
75.0
03
34.0
02
88.0
02
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89.0
04
47.0
03
45.0
03
73.0
02
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0
Acc
iden
t ri
der
$4.
40
$8.
80
$11
.00
$15
.40
$17
.60
$19
.80
$4.
40
$8.
80
$4.
40
$8.
80
MyP
rio
rity
Den
tal
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
MyP
rio
rity
Den
tal P
ro$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41
Pre
ferr
ed p
rem
ium
s
MyP
rio
rity
PP
O
* W
hen
you
age
into
the
next
age
bra
cket
, you
r pr
emiu
ms
will
be a
djus
ted
at y
our
annu
al r
enew
al.
* If
you
mov
e to
a c
ount
y th
at is
in a
diff
eren
t pre
miu
m ta
ble,
you
r pr
emiu
ms
will
be a
djus
ted
on th
e ne
xt b
illing
cyc
le a
fter
you
have
not
ified
us
of y
our
addr
ess
chan
ge.
70%M
edical
60%Brand
/gen
ericdrug
70%M
edical
50%Genericdrugsonly
80%M
edical
60%Brand
/gen
ericdrug
15priorityhealth.com
* W
hen
you
age
into
the
next
age
bra
cket
, you
r pr
emiu
ms
will
be a
djus
ted
at y
our
annu
al r
enew
al.
* If
you
mov
e to
a c
ount
y th
at is
in a
diff
eren
t pre
miu
m ta
ble,
you
r pr
emiu
ms
will
be a
djus
ted
on th
e ne
xt b
illing
cyc
le a
fter
you
have
not
ified
us
of y
our
addr
ess
chan
ge.
Ded
uctib
les
–S
ingl
e(in
-net
wor
k)
–Fa
mily
$1,0
00
$2,0
00$2
,500
$5
,000
$3,5
00
$7,0
00$5
,000
$1
0,00
0$7
,500
$1
5,00
0$1
0,00
0 $2
0,00
0$1
,000
$2
,000
$2,5
00
$5,0
00$1
,000
$2
,000
$3,0
00$6
,000
Co
insu
ranc
e –
in-n
etw
ork
–
out-o
f-net
wor
k80
%
60%
80
%
60%
80
%
60%
80
%60
%
80%
60%
80
%60
%
70%
50
%
70%
50
%
70%
50
%
70%
50
%
Mal
e
0-25
dep
end
ents
$97
.00
$76
.00
$68
.00
$59
.00
$44
.00
$39
.00
$91
.00
$70
.00
$85
.00
$61
.00
0-18
100
.00
78.
00
70.
00
60.
00
45.
00
40.
00
93.
00
72.
00
87.
00
62.
00
19-2
4 1
05.0
08
3.00
7
4.00
6
4.00
4
8.00
4
2.00
9
9.00
7
6.00
9
2.00
6
6.00
25-2
9 1
19.0
09
3.00
8
3.00
7
2.00
5
4.00
4
7.00
1
11.0
08
6.00
9
8.00
7
0.00
30-3
4 1
36.0
01
07.0
09
5.00
8
2.00
6
2.00
5
4.00
1
27.0
09
8.00
1
06.0
07
6.00
35-3
9 1
60.0
01
26.0
01
12.0
09
7.00
7
3.00
6
4.00
1
50.0
01
16.0
01
25.0
09
0.00
40-4
4 1
85.0
01
46.0
01
30.0
01
12.0
08
4.00
7
4.00
1
74.0
01
34.0
01
45.0
01
04.0
0
45-4
9 2
28.0
01
80.0
01
60.0
01
38.0
01
04.0
09
1.00
2
14.0
01
65.0
01
79.0
01
28.0
0
50-5
4 2
90.0
02
28.0
02
03.0
01
75.0
01
32.0
01
15.0
02
71.0
02
10.0
02
27.0
01
63.0
0
55-5
9 3
57.0
02
81.0
02
50.0
02
16.0
01
62.0
01
42.0
03
35.0
02
59.0
02
80.0
02
01.0
0
60-6
44
37.0
03
44.0
03
06.0
02
65.0
01
99.0
01
74.0
04
10.0
03
16.0
03
42.0
02
45.0
0
Acc
iden
t ri
der
$4.
40
$8.
80
$8.
80
$11
.00
$13
.20
$15
.40
$4.
40
$6.
60
$4.
40
$6.
60
MyP
rio
rity
Den
tal
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
MyP
rio
rity
Den
tal P
ro$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41
Fem
ale
0-25
dep
end
ents
$97
.00
$76
.00
$68
.00
$59
.00
$44
.00
$39
.00
$91
.00
$70
.00
$85
.00
$61
.00
0-18
100
.00
78.
00
70.
00
60.
00
45.
00
40.
00
93.
00
72.
00
87.
00
62.
00
19-2
4 1
05.0
08
3.00
7
4.00
6
4.00
4
8.00
4
2.00
9
9.00
7
6.00
9
2.00
6
6.00
25-2
9 1
29.0
01
02.0
09
1.00
7
8.00
5
9.00
5
1.00
1
21.0
09
4.00
1
07.0
07
6.00
30-3
4 1
56.0
01
23.0
01
09.0
09
4.00
7
1.00
6
2.00
1
46.0
01
13.0
01
22.0
08
8.00
35-3
9 2
06.0
01
62.0
01
44.0
01
24.0
09
3.00
8
2.00
1
93.0
01
49.0
01
61.0
01
15.0
0
40-4
4 2
44.0
01
92.0
01
71.0
01
48.0
01
11.0
09
7.00
2
29.0
01
77.0
01
91.0
01
37.0
0
45-4
9 2
85.0
02
24.0
02
00.0
01
73.0
01
30.0
01
13.0
02
67.0
02
06.0
02
23.0
01
60.0
0
50-5
4 3
27.0
02
58.0
02
29.0
01
98.0
01
49.0
01
30.0
03
07.0
02
37.0
02
56.0
01
84.0
0
55-5
9 3
82.0
03
01.0
02
68.0
02
32.0
01
74.0
01
52.0
03
59.0
02
77.0
03
00.0
02
15.0
0
60-6
4 4
50.0
03
54.0
03
15.0
02
73.0
02
05.0
01
79.0
04
22.0
03
26.0
03
53.0
02
53.0
0
Acc
iden
t ri
der
$4.
40
$8.
80
$11
.00
$15
.40
$17
.60
$19
.80
$4.
40
$8.
80
$4.
40
$8.
80
MyP
rio
rity
Den
tal
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
$26.
97$2
6.97
MyP
rio
rity
Den
tal P
ro$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41$3
6.41
$36.
41
Pre
ferr
ed p
rem
ium
s
MyP
rio
rity
PP
O
* W
hen
you
age
into
the
next
age
bra
cket
, you
r pr
emiu
ms
will
be a
djus
ted
at y
our
annu
al r
enew
al.
* If
you
mov
e to
a c
ount
y th
at is
in a
diff
eren
t pre
miu
m ta
ble,
you
r pr
emiu
ms
will
be a
djus
ted
on th
e ne
xt b
illing
cyc
le a
fter
you
have
not
ified
us
of y
our
addr
ess
chan
ge.
Co
unti
es:A
lcon
a,A
lger
,Alp
ena,
Ant
rim,B
arag
a,B
enzi
e,C
harle
voix
,Che
boy
gan,
Chi
pp
ewa,
C
raw
ford
,Del
ta,D
icki
nson
,Em
met
,Gog
ebic
,Gra
ndT
rave
rse,
Hou
ghto
n,Io
sco,
Iron
,Kal
kask
a,
Kew
eena
w,L
eela
nau,
Luc
e,M
acki
nac,
Man
iste
e,M
arq
uett
e,M
enom
inee
,Mis
sauk
ee,M
ontm
oren
cy,
Oge
maw
,Ont
onag
on,O
scod
a,O
tseg
o,P
resq
ueIs
le,R
osco
mm
on,S
choo
lcra
ft,W
exfo
rd
70%M
edical
60%Brand
/gen
ericdrug
80%M
edical
60%Brand
/gen
ericdrug
70%M
edical
50%Genericdrugsonly
16 For more information call 855.MyPriority (855.697.7467)
Co
unti
es:
Jack
son,
Hill
sdal
e
Ded
uctib
le
In-n
etw
ork
$2,0
00S
ingl
e$4
,000
Fam
ily$4
,000
Sin
gle
$8,0
00F
amily
$5,0
00S
ingl
e$1
0,00
0Fa
mily
Mal
e
0-25
dep
end
ents
$83
.00
$64
.00
$59
.00
0-18
85.
00
65.
00
60.
00
19-2
4 9
0.00
6
9.00
6
3.00
25-2
9 1
02.0
07
8.00
7
2.00
30-3
4 1
16.0
08
9.00
8
2.00
35-3
9 1
37.0
01
05.0
09
7.00
40-4
4 1
59.0
01
22.0
01
12.0
0
45-4
9 1
95.0
01
50.0
01
38.0
0
50-5
4 2
48.0
01
90.0
01
75.0
0
55-5
9 3
06.0
02
35.0
02
16.0
0
60-6
43
74.0
02
87.0
02
64.0
0
Acc
iden
t ri
der
$4.
40
$2.
20
$2.
20
MyP
rio
rity
Den
tal
$26.
97$2
6.97
$26.
97
MyP
riorit
y D
enta
l Pro
$36.
41$3
6.41
$36.
41
Fem
ale
0-25
dep
end
ents
$83
.00
$64
.00
$59
.00
0-18
85.
00
65.
00
60.
00
19-2
4 9
0.00
6
9.00
6
3.00
25-2
9 1
11.0
08
5.00
7
8.00
30-3
4 1
33.0
01
02.0
09
4.00
35-3
9 1
76.0
01
35.0
01
24.0
0
40-4
4 2
09.0
01
60.0
01
47.0
0
45-4
9 2
44.0
01
87.0
01
72.0
0
50-5
4 2
80.0
02
15.0
01
97.0
0
55-5
9 3
27.0
02
51.0
02
31.0
0
60-6
4 3
85.0
02
95.0
02
71.0
0
Acc
iden
t ri
der
$4.
40
$4.
40
$4.
40
MyP
rio
rity
Den
tal
$26.
97$2
6.97
$26.
97
MyP
riorit
y D
enta
l Pro
$36.
41$3
6.41
$36.
41
Co
unti
es:K
alam
azoo
,Len
awee
,Liv
ings
ton,
Mac
omb
,Mon
roe,
Oak
land
,St.
Cla
ir,
Was
hten
aw,W
ayne
Ded
uctib
le
In-n
etw
ork
$2,0
00S
ingl
e$4
,000
Fam
ily$4
,000
Sin
gle
$8,0
00F
amily
$5,0
00S
ingl
e$1
0,00
0Fa
mily
Mal
e
0-25
dep
end
ents
$87
.00
$67
.00
$61
.00
0-18
89.
00
68.
00
63.
00
19-2
4 9
4.00
7
2.00
6
6.00
25-2
9 1
06.0
08
2.00
7
5.00
30-3
4 1
22.0
09
3.00
8
6.00
35-3
9 1
44.0
01
10.0
01
01.0
0
40-4
4 1
66.0
01
27.0
01
17.0
0
45-4
9 2
05.0
01
57.0
01
44.0
0
50-5
4 2
60.0
01
99.0
01
83.0
0
55-5
9 3
20.0
02
46.0
02
26.0
0
60-6
43
92.0
03
00.0
02
76.0
0
Acc
iden
t ri
der
$4.
40
$2.
20
$2.
20
MyP
rio
rity
Den
tal
$26.
97$2
6.97
$26.
97
MyP
riorit
y D
enta
l Pro
$36.
41$3
6.41
$36.
41
Fem
ale
0-25
dep
end
ents
$87
.00
$67
.00
$61
.00
0-18
89.
00
68.
00
63.
00
19-2
4 9
4.00
7
2.00
6
6.00
25-2
9 1
16.0
08
9.00
8
2.00
30-3
4 1
40.0
01
07.0
09
8.00
35-3
9 1
84.0
01
41.0
01
30.0
0
40-4
4 2
19.0
01
68.0
01
54.0
0
45-4
9 2
55.0
01
96.0
01
80.0
0
50-5
4 2
93.0
02
25.0
02
07.0
0
55-5
9 3
43.0
02
63.0
02
42.0
0
60-6
4 4
04.0
03
09.0
02
84.0
0
Acc
iden
t ri
der
$4.
40
$4.
40
$4.
40
MyP
rio
rity
Den
tal
$26.
97$2
6.97
$26.
97
MyP
riorit
y D
enta
l Pro
$36.
41$3
6.41
$36.
41
Pre
ferr
ed p
rem
ium
s
MyP
rio
rity
HS
A
* W
hen
you
age
into
the
next
age
bra
cket
, you
r pr
emiu
ms
will
be a
djus
ted
at y
our
annu
al r
enew
al.
* If
you
mov
e to
a c
ount
y th
at is
in a
diff
eren
t pre
miu
m ta
ble,
you
r pr
emiu
ms
will
be a
djus
ted
on th
e ne
xt b
illing
cyc
le a
fter
you
have
not
ified
us
of y
our
addr
ess
chan
ge.
17priorityhealth.com
Co
unti
es:A
lcon
a,A
lger
,Alp
ena,
Ant
rim,B
arag
a,B
enzi
e,C
harle
voix
,Che
boy
gan,
C
hip
pew
a,C
raw
ford
,Del
ta,D
icki
nson
,Em
met
,Gog
ebic
,Gra
ndT
rave
rse,
Hou
ghto
n,
Iosc
o,Ir
on,K
alka
ska,
Kew
eena
w,L
eela
nau,
Luc
e,M
acki
nac,
Man
iste
e,M
arq
uett
e,
Men
omin
ee,M
issa
ukee
,Mon
tmor
ency
,Oge
maw
,Ont
onag
on,O
ceol
a,O
scod
a,O
tseg
o,
Pre
sque
Isle
,Ros
com
mon
,Sch
oolc
raft
,Wex
ford
Ded
uctib
le
In-n
etw
ork
$2,0
00S
ingl
e$4
,000
Fam
ily$4
,000
Sin
gle
$8,0
00F
amily
$5,0
00S
ingl
e$1
0,00
0Fa
mily
Mal
e
0-25
dep
end
ents
$75
.00
$58
.00
$53
.00
0-18
77.
00
59.
00
54.
00
19-2
4 8
1.00
6
2.00
5
7.00
25-2
9 9
2.00
7
0.00
6
5.00
30-3
4 1
05.0
08
0.00
7
4.00
35-3
9 1
24.0
09
5.00
8
7.00
40-4
4 1
43.0
01
10.0
01
01.0
0
45-4
9 1
77.0
01
36.0
01
25.0
0
50-5
4 2
24.0
01
72.0
01
58.0
0
55-5
9 2
77.0
02
12.0
01
95.0
0
60-6
43
38.0
02
59.0
02
38.0
0
Acc
iden
t ri
der
$4.
40
$2.
20
$2.
20
MyP
rio
rity
Den
tal
$26.
97$2
6.97
$26.
97
MyP
riorit
y D
enta
l Pro
$36.
41$3
6.41
$36.
41
Fem
ale
0-25
dep
end
ents
$75
.00
$58
.00
$53
.00
0-18
77.
00
59.
00
54.
00
19-2
4 8
1.00
6
2.00
5
7.00
25-2
9 1
00.0
07
7.00
7
1.00
30-3
4 1
21.0
09
3.00
8
5.00
35-3
9 1
59.0
01
22.0
01
12.0
0
40-4
4 1
89.0
01
45.0
01
33.0
0
45-4
9 2
21.0
01
69.0
01
55.0
0
50-5
4 2
53.0
01
94.0
01
78.0
0
55-5
9 2
96.0
02
27.0
02
09.0
0
60-6
4 3
49.0
02
67.0
02
46.0
0
Acc
iden
t ri
der
$4.
40
$4.
40
$4.
40
MyP
rio
rity
Den
tal
$26.
97$2
6.97
$26.
97
MyP
riorit
y D
enta
l Pro
$36.
41$3
6.41
$36.
41
Co
unti
es:A
llega
n,A
rena
c,B
arry
,Bay
,Ber
rien,
Bra
nch,
Cal
houn
,Cas
s,C
lare
,Clin
ton,
E
aton
,Gen
esee
,Gla
dw
in,G
ratio
t,H
uron
,Ing
ham
,Ion
ia,I
sab
ella
,Ken
t,L
ake,
Lap
eer,
Mas
on,M
ecos
ta,M
idla
nd,M
ontc
alm
,Mus
kego
n,N
eway
go,O
cean
a,O
ceol
a,O
ttaw
a,
Sag
inaw
,St.
Jos
eph,
San
ilac,
Shi
awas
ee,T
usco
la,V
anB
uren
Ded
uctib
le
In-n
etw
ork
$2,0
00S
ingl
e$4
,000
Fam
ily$4
,000
Sin
gle
$8,0
00F
amily
$5,0
00S
ingl
e$1
0,00
0Fa
mily
Mal
e
0-25
dep
end
ents
$80
.00
$61
.00
$56
.00
0-18
82.
00
63.
00
57.
00
19-2
4 8
6.00
6
6.00
6
1.00
25-2
9 9
7.00
7
4.00
6
8.00
30-3
4 1
11.0
08
5.00
7
8.00
35-3
9 1
31.0
01
01.0
09
2.00
40-4
4 1
52.0
01
16.0
01
07.0
0
45-4
9 1
87.0
01
43.0
01
32.0
0
50-5
4 2
37.0
01
82.0
01
67.0
0
55-5
9 2
93.0
02
24.0
02
06.0
0
60-6
43
58.0
02
74.0
02
52.0
0
Acc
iden
t ri
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MyP
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