| Field | Data |
|---|---|
| Health Insurance Plan ID | 29698MI0540390 |
| Health Insurance Plan Year | 2022 |
| State | Michigan |
| Health Insurance Issuer | Priority Health |
| Plan Formulary Description URL | Formulary URL |
| Plan Marketing Materials URL | Marketing URL |
| Last Plan Update Date | Wed, 22 Sep 2021 00:00 GMT |
| Last Import Date | Tue, 21 Mar 2023 13:10 GMT |
| Health Insurance Plan Variant | 29698MI0540390-01 |
| Available Variants of the Health Plan | |
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.789704156 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2022 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Gold On Exchange Plan |
| Dental Only Plan | No |
| Disease Management Programs Offered | Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs |
| EHB Percent of Total Premium | 1 |
| First Tier Utilization | 100% |
| Formulary ID | MIF008 |
| Formulary URL | URL |
| HIOS Product ID | 29698MI054 |
| Import Date | 8/17/2021 20:00 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 29698 |
| Issuer Marketplace Marketing Name | Priority Health |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Gold |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | MIN007 |
| Out of Country Coverage | Yes |
| Out of Country Coverage Description | Emergency Care Only |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Urgent/Emergency Care Only |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan Expiration Date | 12/31/2022 |
| Plan ID (Standard Component ID with Variant) | 29698MI0540390-01 |
| Plan Marketing Name | MyPriority Gold 1100 |
| Plan Type | HMO |
| Plan Variant Marketing Name | MyPriority Gold 1100 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $7,100 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $1,100 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $3,300 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $1,100 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $1,300 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $1,100 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | MIS001 |
| Source Name | SERFF |
| Plan ID | 29698MI0540390 |
| State Code | MI |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 20.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $2200 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $1100 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $1,100 |
| TEHBDedOutOfNetFamilyPerGroup | per group not applicable |
| TEHBDedOutOfNetFamilyPerPerson | per person not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $16300 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $8150 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $8,150 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|---|---|---|---|---|---|
| Generic | 1 month in retail | $0 | 20.0% | After deductible | YES | |
| Generic preferred brand specialty drugs | 1 month in retail | $0 | 20.0% | After deductible | NO | |
| Medical service drugs | 1 month in retail | $0 | 0% | NO | ||
| Non preferred brand | 1 month in retail | $0 | 20.0% | After deductible | YES | |
| Non preferred brand specialty drugs | 1 month in retail | $0 | 20.0% | After deductible | NO | |
| Preferred brand | 1 month in retail | $0 | 20.0% | After deductible | YES |
Frequently Asked Questions(FAQ) about MyPriority Gold 1100, 29698MI0540390 Health Insurance Plan, 29698MI0540390
Does MyPriority Gold 1100 Health Insurance Plan, 29698MI0540390 support Mail Ordering?
Yes, MyPriority Gold 1100 Health Insurance
Plan, 29698MI0540390 supports mail ordering for the next drug tiers: Generic, Non preferred brand, Preferred brand
What are the Generic Medications coinsurance & copay options with MyPriority Gold 1100 (29698MI0540390) Health Insurance Plan?
For generic drug tier coinsurance (After deductible) is 20.0%, generic preferred brand specialty drugs drug tier coinsurance (After deductible) is 20.0%
What are the copay and coinsurance options for Brand Drugs with MyPriority Gold 1100 Health Insurance Plan (29698MI0540390)?
For generic preferred brand specialty drugs drug tier coinsurance (After deductible) is 20.0%, non preferred brand drug tier coinsurance (After deductible) is 20.0%, non preferred brand specialty drugs drug tier coinsurance (After deductible) is 20.0%, preferred brand drug tier coinsurance (After deductible) is 20.0%
What are the copay and coinsurance options for Brand Drugs with MyPriority Gold 1100 Health Insurance Plan (29698MI0540390)?
, generic preferred brand specialty drugs drug tier coinsurance (After deductible) is 20.0%, non preferred brand drug tier coinsurance (After deductible) is 20.0%, non preferred brand specialty drugs drug tier coinsurance (After deductible) is 20.0%, preferred brand drug tier coinsurance (After deductible) is 20.0%
Does (29698MI0540390) Health Insurance Plan, Variant (29698MI0540390-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Does (29698MI0540390) Health Insurance Plan, Variant (29698MI0540390-01) have Out Of Country Coverage?
Yes. Details: Emergency Care Only
Does (29698MI0540390) Health Insurance Plan, Variant (29698MI0540390-01) have Out of Service Area Coverage?
Yes. Details: Urgent/Emergency Care Only
Does (29698MI0540390) Health Insurance Plan, Variant (29698MI0540390-01) offer Disease Management Programs?
Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Does MyPriority Gold 1100 Health Insurance Plan, Variant (29698MI0540390-01) offer Disease Management Programs for Asthma?
Yes, the MyPriority Gold 1100 Health Insurance Plan Variant 29698MI0540390-01 offers Disease Management Program for Asthma.
Does MyPriority Gold 1100 Health Insurance Plan, Variant (29698MI0540390-01) offer Disease Management Programs for Heart disease?
Yes, the MyPriority Gold 1100 Health Insurance Plan Variant 29698MI0540390-01 offers Disease Management Program for Heart disease.
Does MyPriority Gold 1100 Health Insurance Plan, Variant (29698MI0540390-01) offer Disease Management Programs for Depression?
Yes, the MyPriority Gold 1100 Health Insurance Plan Variant 29698MI0540390-01 offers Disease Management Program for Depression.
Does MyPriority Gold 1100 Health Insurance Plan, Variant (29698MI0540390-01) offer Disease Management Programs for Diabetes?
Yes, the MyPriority Gold 1100 Health Insurance Plan Variant 29698MI0540390-01 offers Disease Management Program for Diabetes.
Does MyPriority Gold 1100 Health Insurance Plan, Variant (29698MI0540390-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Yes, the MyPriority Gold 1100 Health Insurance Plan Variant 29698MI0540390-01 offers Disease Management Program for High blood pressure & high cholesterol.
Does MyPriority Gold 1100 Health Insurance Plan, Variant (29698MI0540390-01) offer Disease Management Programs for Low back pain?
Yes, the MyPriority Gold 1100 Health Insurance Plan Variant 29698MI0540390-01 offers Disease Management Program for Low back pain.
Does MyPriority Gold 1100 Health Insurance Plan, Variant (29698MI0540390-01) offer Disease Management Programs for Pain management?
Yes, the MyPriority Gold 1100 Health Insurance Plan Variant 29698MI0540390-01 offers Disease Management Program for Pain management.
Does MyPriority Gold 1100 Health Insurance Plan, Variant (29698MI0540390-01) offer Disease Management Programs for Pregnancy?
Yes, the MyPriority Gold 1100 Health Insurance Plan Variant 29698MI0540390-01 offers Disease Management Program for Pregnancy.
Does MyPriority Gold 1100 Health Insurance Plan, Variant (29698MI0540390-01) offer Disease Management Programs for Weight loss programs?
Yes, the MyPriority Gold 1100 Health Insurance Plan Variant 29698MI0540390-01 offers Disease Management Program for Weight loss programs.
Disclaimer: This is based on the import(Date: Tue, 21 Mar 2023 13:10 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API