MyPriority Silver 5500 - Ascension St. John Providence Network - 29698MI0540564 Health Insurance Plan

Priority Health health insurance plan with the Plan ID 29698MI0540564. The plan is called MyPriority Silver 5500 - Ascension St. John Providence Network.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 30.00% of the costs of all covered benefits (according to the Issuer).

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 72.24% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 27.76% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.

Health Insurance Plan ID 29698MI0540564
Health Insurance Plan Year 2022
State Michigan
Health Insurance Issuer Priority Health
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 29698MI0540564-00
Provider Network(s) ['MIN005']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Wed, 27 Mar 2024 12:10 GMT).

Providers Michigan All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard Off Exchange Plan - 29698MI0540564-00

Standard On Exchange Plan - 29698MI0540564-01

Open to Indians below 300% FPL - 29698MI0540564-02

Open to Indians above 300% FPL - 29698MI0540564-03

73% AV Silver Plan - 29698MI0540564-04

87% AV Silver Plan - 29698MI0540564-05

94% AV Silver Plan - 29698MI0540564-06

Last Plan Update Date Tue, 17 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan Variant 29698MI0540564-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.722359898
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 Silver Off 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 MIF005
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 New
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 70.00%
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 Silver
Multiple In Network Tiers No
National Network No
Network ID MIN005
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) 29698MI0540564-00
Plan Marketing Name MyPriority Silver 5500 - Ascension St. John Providence Network
Plan Type HMO
Plan Variant Marketing Name MyPriority Silver 5500 - Ascension St. John Providence Network
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $3,000
SBC Scenario, Having a Baby, Copayment $200
SBC Scenario, Having a Baby, Deductible $5,500
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,600
SBC Scenario, Having Diabetes, Deductible $800
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,500
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID MIS005
Source Name SERFF
Plan ID 29698MI0540564
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 30.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $11000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $5500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $5,500
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person 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 $17400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8700 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,700
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 Yes
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan, 29698MI0540564

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about MyPriority Silver 5500 - Ascension St. John Providence Network, 29698MI0540564 Health Insurance Plan, 29698MI0540564

  • Does MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan, 29698MI0540564 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (29698MI0540564) Health Insurance Plan, Variant (29698MI0540564-00) 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 (29698MI0540564) Health Insurance Plan, Variant (29698MI0540564-00) have Out Of Country Coverage?

    Yes. Details: Emergency Care Only

    Does (29698MI0540564) Health Insurance Plan, Variant (29698MI0540564-00) have Out of Service Area Coverage?

    Yes. Details: Urgent/Emergency Care Only

    Does (29698MI0540564) Health Insurance Plan, Variant (29698MI0540564-00) 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 Silver 5500 - Ascension St. John Providence Network Health Insurance Plan, Variant (29698MI0540564-00) offer Disease Management Programs for Asthma?

    Yes, the MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan Variant 29698MI0540564-00 offers Disease Management Program for Asthma.

    Does MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan, Variant (29698MI0540564-00) offer Disease Management Programs for Heart disease?

    Yes, the MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan Variant 29698MI0540564-00 offers Disease Management Program for Heart disease.

    Does MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan, Variant (29698MI0540564-00) offer Disease Management Programs for Depression?

    Yes, the MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan Variant 29698MI0540564-00 offers Disease Management Program for Depression.

    Does MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan, Variant (29698MI0540564-00) offer Disease Management Programs for Diabetes?

    Yes, the MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan Variant 29698MI0540564-00 offers Disease Management Program for Diabetes.

    Does MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan, Variant (29698MI0540564-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan Variant 29698MI0540564-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan, Variant (29698MI0540564-00) offer Disease Management Programs for Low back pain?

    Yes, the MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan Variant 29698MI0540564-00 offers Disease Management Program for Low back pain.

    Does MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan, Variant (29698MI0540564-00) offer Disease Management Programs for Pregnancy?

    Yes, the MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan Variant 29698MI0540564-00 offers Disease Management Program for Pregnancy.

    Does MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan, Variant (29698MI0540564-00) offer Disease Management Programs for Weight loss programs?

    Yes, the MyPriority Silver 5500 - Ascension St. John Providence Network Health Insurance Plan Variant 29698MI0540564-00 offers Disease Management Program for Weight loss programs.

 

Disclaimer: This is based on the import(Date: Wed, 27 Mar 2024 12:10 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