MyPriority HSA Bronze 7100 – Spectrum Health Partners

29698MI0540601
Expanded Bronze
HMO

MyPriority HSA Bronze 7100 – Spectrum Health Partners is an Expanded Bronze HMO plan by Priority Health.

IMPORTANT: You are viewing the 2023 version of MyPriority HSA Bronze 7100 – Spectrum Health Partners 29698MI0540601. You can enroll in this plan during open enrollment 2023, which started November 1st and ends January 15th, 2023, in most states.

Locations

MyPriority HSA Bronze 7100 – Spectrum Health Partners is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of MyPriority HSA Bronze 7100 – Spectrum Health Partners 29698MI0540601.
Insurer: Priority Health
Network Type: HMO
Metal Type: Expanded Bronze
HSA Eligible?: Yes
Plan ID: 29698MI0540601

Cost-Sharing Overview

MyPriority HSA Bronze 7100 – Spectrum Health Partners offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for MyPriority HSA Bronze 7100 - Spectrum Health Partners?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

MyPriority HSA Bronze 7100 – Spectrum Health Partners offers the following features and referral requirements.

Wellness Program: No
Disease Program: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs
Notice Pregnancy: No
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what MyPriority HSA Bronze 7100 – Spectrum Health Partners covers when you are out of the service area or out of the country.

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
National Network: No

Additional Benefits and Cost-Sharing

MyPriority HSA Bronze 7100 – Spectrum Health Partners includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Primary Care Visit to Treat an Injury or Illness
Covered
No Charge after deductible 100.00% This plan includes one annual physical/wellness exam at no cost to the member.
Specialist Visit
Covered
No Charge after deductible 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
No Charge after deductible 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
No Charge after deductible 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
No Charge after deductible 100.00%
Hospice Services
Covered
No Charge after deductible 100.00%
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Covered
No Charge after deductible 100.00% Limits and exclusions apply. Diagnosis and treatment of underlying cause only. See SBC document.
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Not Covered
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
No Charge after deductible 100.00%
Home Health Care Services
Covered
No Charge after deductible 100.00% Including hospice care in the home.
Emergency Room Services
Covered
No Charge after deductible 100.00%
Emergency Transportation/Ambulance
Covered
No Charge after deductible 100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
No Charge after deductible 100.00%
Inpatient Physician and Surgical Services
Covered
No Charge after deductible 100.00%
Bariatric Surgery
Covered
No Charge after deductible 100.00%1 Procedure(s) per Lifetime One procedure per lifetime.
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
No Charge after deductible 100.00%45 Days per Year Up to 45 days per benefit period. This limit is combined with hospice facility, subacute facility, and inpatient rehabilitation care facility services.
Prenatal and Postnatal Care
Covered
No Charge 100.00% Routine care is covered as preventive. Complications of Pregnancy is diagnostic/medical care will be covered as indicated by the SBC document.
Delivery and All Inpatient Services for Maternity Care
Covered
No Charge after deductible 100.00%
Mental/Behavioral Health Outpatient Services
Covered
No Charge after deductible 100.00%
Mental/Behavioral Health Inpatient Services
Covered
No Charge after deductible 100.00%
Substance Abuse Disorder Outpatient Services
Covered
No Charge after deductible 100.00%
Substance Abuse Disorder Inpatient Services
Covered
No Charge after deductible 100.00%
Generic Drugs
Covered
No Charge after deductible 100.00% Refer to the drug list for quantity limits and other exclusions.
Preferred Brand Drugs
Covered
No Charge after deductible 100.00% Refer to the drug list for quantity limits and other exclusions.
Non-Preferred Brand Drugs
Covered
No Charge after deductible 100.00% Refer to the drug list for quantity limits and other exclusions.
Specialty Drugs
Covered
No Charge after deductible 100.00% Refer to the drug list for quantity limits and other exclusions.
Outpatient Rehabilitation Services
Covered
No Charge after deductible 100.00%90 Visit(s) per Year Up to 90 visits per year: limited to 30 speech therapy visits, 30 occupational and physical therapy, and 30 cardiac and pulmonary rehabilitation visits per member per year. See SBC for details.
Habilitation Services
Covered
No Charge after deductible 100.00%60 Visit(s) per Year Up to 60 visits per year: limited to 30 speech therapy visits and 30 occupational and physical therapy rehabilitation visits per member per year (non-Autism Spectrum Disorder). See SBC for details.
Chiropractic Care
Covered
No Charge after deductible 100.00%30 Visit(s) per Year Maximum 30 visits per member per year combined with rehabilitative occupational and physical therapy.
Durable Medical Equipment
Covered
No Charge after deductible 100.00%
Hearing Aids
Not Covered
Imaging (CT/PET Scans, MRIs)
Covered
No Charge after deductible 100.00%
Preventive Care/Screening/Immunization
Covered
No Charge 100.00%
Routine Foot Care
Not Covered
Acupuncture
Not Covered
Weight Loss Programs
Covered
No Charge after deductible 100.00%
Routine Eye Exam for Children
Covered
No Charge 100.00%1 Exam(s) per Year One exam per year. See SBC for details.
Eye Glasses for Children
Covered
No Charge 100.00%1 Item(s) per Year One select eyeglass frame and one set of lenses, or provider designated contact lenses in lieu of eyeglass frames and lenses, per year.
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
No Charge after deductible 100.00%30 Visit(s) per Year Maximum of 30 visits per year.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
No Charge after deductible 100.00%30 Visit(s) per Year Combined maximum of 30 visits per year. Combined with Chiropractic Care
Well Baby Visits and Care
Covered
No Charge 100.00%
Laboratory Outpatient and Professional Services
Covered
No Charge after deductible 100.00%
X-rays and Diagnostic Imaging
Covered
No Charge after deductible 100.00%
Basic Dental Care – Child
Not Covered
Orthodontia – Child
Not Covered
Major Dental Care – Child
Not Covered
Basic Dental Care – Adult
Not Covered
Orthodontia – Adult
Not Covered
Major Dental Care – Adult
Not Covered
Abortion for Which Public Funding is Prohibited
Not Covered
Transplant
Covered
No Charge after deductible 100.00%
Accidental Dental
Not Covered
Dialysis
Covered
No Charge after deductible 100.00%
Allergy Testing
Covered
No Charge after deductible 100.00%
Chemotherapy
Covered
No Charge after deductible 100.00%
Radiation
Covered
No Charge after deductible 100.00%
Diabetes Education
Covered
No Charge 100.00%
Prosthetic Devices
Covered
No Charge after deductible 100.00%
Infusion Therapy
Covered
No Charge after deductible 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
No Charge after deductible 100.00% Coverage includes medical care or services to treat dysfunction or TMJS resulting from a medical cause or Injury, Office visits for medical evaluation and treatment, X-rays of the temporomandibular joint including contrast studies, but not dental x-rays, Myofunctional therapy and Surgery to the temporomandibular joint, such as condylectomy, meniscectomy, arthrotomy, and arthrocentesis.
Nutritional Counseling
Covered
No Charge 100.00%6 Visit(s) per Year Maximum of six visits per year of nutritional counseling/dietician services.
Reconstructive Surgery
Covered
No Charge after deductible 100.00%
Gender Affirming Care
Covered
No Charge after deductible 100.00%
Applied Behavior Analysis Based Therapies
Covered
No Charge after deductible 100.00% Only covered in relation to Autism Spectrum Disorder.
Autism Spectrum Disorders
Covered
No Charge after deductible 100.00% Only covered in relation to Autism Spectrum Disorder.

Free Preventive Services

There is no copayment or coinsurance for any of the following MyPriority HSA Bronze 7100 – Spectrum Health Partners preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for MyPriority HSA Bronze 7100 – Spectrum Health Partners including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for MyPriority HSA Bronze 7100 - Spectrum Health Partners?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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