MyPriority Value Bronze HSA Southeast Michigan Network

Priority Health

Expanded BronzeHSA eligible

Ind. deductible: $7,500
Family deductible: $7,500
Ind. OOP max: $7,500
Family OOP max: $7,500

Other cost-sharing reduction variants for this plan:

Limited Cost Sharing Plan Variation Standard Bronze Off Exchange Plan Zero Cost Sharing Plan Variation

Monthly premiums by age

Age	Individual	Individual + tobacco
21	$323	—
30	$367	—
40	$413	—
50	$577	—
60	$877	—

Live premium estimate

Benefits & cost sharing

Primary Care

Benefit	In-network
Preventive Care/Screening/Immunization	No charge
Primary Care Visit to Treat an Injury or Illness	$0.00

Specialist

Benefit	In-network
Specialist Visit	No Charge after deductible

Hospital

Benefit	In-network
Emergency Room Services	No Charge after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	No Charge after deductible
Outpatient Surgery Physician/Surgical Services	No Charge after deductible
Urgent Care Centers or Facilities	No Charge after deductible

Pharmacy

Benefit	In-network
Generic Drugs	No Charge after deductible
Non-Preferred Brand Drugs	$0.00
Preferred Brand Drugs	No Charge after deductible
Specialty Drugs	No Charge after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	No Charge after deductible
Mental/Behavioral Health Outpatient Services	No Charge after deductible

Other

Benefit	In-network
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	Not covered
Acupuncture	Not covered
Allergy Testing	$0.00
Applied Behavior Analysis Based Therapies	No Charge after deductible
Autism Spectrum Disorders	No Charge after deductible
Bariatric Surgery	No Charge after deductible
Basic Dental Care - Adult	Not covered
Basic Dental Care - Child	Not covered
Chemotherapy	No Charge after deductible
Chiropractic Care	$0.00
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	No Charge after deductible
Dental Check-Up for Children	Not covered
Diabetes Education	No charge
Dialysis	No Charge after deductible
Durable Medical Equipment	$0.00
Emergency Transportation/Ambulance	$0.00
Eye Glasses for Children	No charge
Habilitation Services	No Charge after deductible
Hearing Aids	Not covered
Home Health Care Services	No Charge after deductible
Hospice Services	No Charge after deductible
Imaging (CT/PET Scans, MRIs)	$0.00
Infertility Treatment	No Charge after deductible
Infusion Therapy	$0.00
Inpatient Physician and Surgical Services	No Charge after deductible
Laboratory Outpatient and Professional Services	$0.00
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	Not covered
Major Dental Care - Child	Not covered
Nutritional Counseling	No charge
Orthodontia - Adult	Not covered
Orthodontia - Child	Not covered
Other Practitioner Office Visit (Nurse, Physician Assistant)	No Charge after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	No Charge after deductible
Outpatient Rehabilitation Services	No Charge after deductible
Prenatal and Postnatal Care	No charge
Private-Duty Nursing	Not covered
Prosthetic Devices	$0.00
Radiation	$0.00
Reconstructive Surgery	No Charge after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	No Charge after deductible
Rehabilitative Speech Therapy	No Charge after deductible
Routine Dental Services (Adult)	Not covered
Routine Eye Exam (Adult)	Not covered
Routine Eye Exam for Children	No charge
Routine Foot Care	Not covered
Skilled Nursing Facility	No Charge after deductible
Specified Sex-Trait Modification Procedures	No Charge after deductible
Substance Abuse Disorder Inpatient Services	No Charge after deductible
Substance Abuse Disorder Outpatient Services	No Charge after deductible
Transplant	$0.00
Treatment for Temporomandibular Joint Disorders	$0.00
Weight Loss Programs	No Charge after deductible
Well Baby Visits and Care	$0.00
X-rays and Diagnostic Imaging	No Charge after deductible

Plan rules

Service area

This plan covers 3 geographic areas.