MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) - 29698MI0541037 Health Insurance Plan
Priority Health health insurance plan with the Plan ID 29698MI0541037. The plan is called MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry).
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 72.08% (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 27.92% 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 | 29698MI0541037 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Michigan | ||||||||||||||||||
| Health Insurance Issuer | Priority Health | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 29698MI0541037-00 | ||||||||||||||||||
| Provider Network(s) | NONPREFERRED COREWELL-WEST-NARROW-HMO | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 04 Nov 2025 05:30 GMT). |
|
||||||||||||||||||
| Available Variants of the Health Plan | Standard Off Exchange Plan - 29698MI0541037-00 Standard On Exchange Plan - 29698MI0541037-01 Open to Indians below 300% FPL - 29698MI0541037-02 Open to Indians above 300% FPL - 29698MI0541037-03 73% AV Silver Plan - 29698MI0541037-04 |
||||||||||||||||||
| Last Plan Update Date | Tue, 13 Aug 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 04 Nov 2025 05:30 GMT |
Benefits of MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) Health Insurance Plan, 29698MI0541037-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
Exclusions: nan nan |
NO | ||
| Accidental Dental
Exclusions: nan nan |
NO | ||
| Acupuncture
Exclusions: nan nan |
NO | ||
| Allergy Testing
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Applied Behavior Analysis Based Therapies
Exclusions: nan Only covered in relation to Autism Spectrum Disorder. |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Autism Spectrum Disorders
Exclusions: nan Only covered in relation to Autism Spectrum Disorder. |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Bariatric Surgery
Limit: 1.0 Procedure(s) per Lifetime Exclusions: nan One procedure per lifetime. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Basic Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Child
Exclusions: nan nan |
NO | ||
| Chemotherapy
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Chiropractic Care
Limit: 30.0 Visit(s) per Year Exclusions: nan Maximum 30 visits per member per year. |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Cosmetic Surgery
Exclusions: nan nan |
NO | ||
| Delivery and All Inpatient Services for Maternity Care
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Dental Check-Up for Children
Exclusions: nan nan |
NO | ||
| Diabetes Education
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Dialysis
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Durable Medical Equipment
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Emergency Room Services
Exclusions: nan nan |
YES | $250.00 Copay after deductible, 30.00% Coinsurance after deductible |
$250.00 Copay after deductible, 30.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance
Exclusions: nan nan |
YES | $250.00 Copay after deductible, 30.00% Coinsurance after deductible |
$250.00 Copay after deductible, 30.00% Coinsurance after deductible |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year Exclusions: nan One select eyeglass frame and one set of lenses, or provider designated contact lenses in lieu of eyeglass frames and lenses, per year. |
YES | No Charge |
100.00% |
| Gender Affirming Care
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Generic Drugs
Exclusions: nan Refer to the drug list for quantity limits and other exclusions. |
YES | $5.00 |
100.00% |
| Habilitation Services
Limit: 60.0 Visit(s) per Year Exclusions: nan 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. |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Hearing Aids
Exclusions: nan nan |
NO | ||
| Home Health Care Services
Exclusions: nan Including hospice care in the home. |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Hospice Services
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Imaging (CT/PET Scans, MRIs)
Exclusions: nan nan |
YES | $150.00 Copay after deductible, 30.00% Coinsurance after deductible |
100.00% |
| Infertility Treatment
Exclusions: nan Limits and exclusions apply. Diagnosis and treatment of underlying cause only. See SBC document. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Infusion Therapy
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Inpatient Physician and Surgical Services
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Laboratory Outpatient and Professional Services
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Long-Term/Custodial Nursing Home Care
Exclusions: nan nan |
NO | ||
| Major Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Major Dental Care - Child
Exclusions: nan nan |
NO | ||
| Mental/Behavioral Health Inpatient Services
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Mental/Behavioral Health Outpatient Services
Exclusions: nan nan |
YES | $30.00 |
100.00% |
| Non-Preferred Brand Drugs
Exclusions: nan Refer to the drug list for quantity limits and other exclusions. |
YES | $100.00 Copay after deductible |
100.00% |
| Nutritional Counseling
Exclusions: nan Dietician Services. |
YES | No Charge |
100.00% |
| Orthodontia - Adult
Exclusions: nan nan |
NO | ||
| Orthodontia - Child
Exclusions: nan nan |
NO | ||
| Other Practitioner Office Visit (Nurse, Physician Assistant)
Exclusions: nan nan |
YES | $70.00 |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Exclusions: nan nan |
YES | $1000.00 Copay after deductible, 30.00% Coinsurance after deductible |
100.00% |
| Outpatient Rehabilitation Services
Limit: 90.0 Visit(s) per Year Exclusions: nan 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. |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Outpatient Surgery Physician/Surgical Services
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Preferred Brand Drugs
Exclusions: nan Refer to the drug list for quantity limits and other exclusions. |
YES | $75.00 Copay after deductible |
100.00% |
| Prenatal and Postnatal Care
Exclusions: nan Routine care is covered as preventive. Complications of Pregnancy is diagnostic/medical care will be covered as indicated by the SBC document. |
YES | No Charge |
100.00% |
| Preventive Care/Screening/Immunization
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
Exclusions: nan This plan includes one annual physical/wellness exam at no cost to the member. See plan documentation for available $10 virtual care cost share. |
YES | $30.00 |
100.00% |
| Private-Duty Nursing
Exclusions: nan nan |
NO | ||
| Prosthetic Devices
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Radiation
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Reconstructive Surgery
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 30.0 Visit(s) per Year Exclusions: nan Combined maximum of 30 visits per year. |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Rehabilitative Speech Therapy
Limit: 30.0 Visit(s) per Year Exclusions: nan Maximum of 30 visits per year. |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Routine Dental Services (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam for Children
Limit: 1.0 Exam(s) per Year Exclusions: nan One exam per year. See SBC for details. |
YES | No Charge |
100.00% |
| Routine Foot Care
Exclusions: nan nan |
NO | ||
| Skilled Nursing Facility
Limit: 45.0 Days per Year Exclusions: nan Up to 45 days per benefit period. This limit is combined with hospice facility, subacute facility, and inpatient rehabilitation care facility services. |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Specialist Visit
Exclusions: nan nan |
YES | $70.00 |
100.00% |
| Specialty Drugs
Exclusions: nan Refer to the drug list for quantity limits and other exclusions. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Substance Abuse Disorder Inpatient Services
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Substance Abuse Disorder Outpatient Services
Exclusions: nan nan |
YES | $0.00 |
100.00% |
| Transplant
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Treatment for Temporomandibular Joint Disorders
Exclusions: nan 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. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Urgent Care Centers or Facilities
Exclusions: nan nan |
YES | $75.00 |
100.00% |
| Weight Loss Programs
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
| Well Baby Visits and Care
Exclusions: nan nan |
YES | No Charge |
100.00% |
| X-rays and Diagnostic Imaging
Exclusions: nan nan |
YES | 30.00% Coinsurance after deductible |
100.00% |
MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) Health Insurance Plan Variant 29698MI0541037-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.720753622973454 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2025 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Silver Off Exchange Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs |
| EHB Percent of Total Premium | 1.0 |
| First Tier Utilization | 100% |
| Formulary ID | MIF003 |
| Formulary URL | URL |
| HIOS Product ID | 29698MI054 |
| Import Date | 2024-08-13 20:01:38 |
| 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 | MIN002 |
| 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 | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 29698MI0541037-00 |
| Plan Marketing Name | MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) |
| Plan Type | HMO |
| Plan Variant Marketing Name | MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,700 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $3,400 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $80 |
| SBC Scenario, Having Diabetes, Copayment | $700 |
| SBC Scenario, Having Diabetes, Deductible | $3,400 |
| 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 | MIS003 |
| Source Name | SERFF |
| Plan ID | 29698MI0541037 |
| 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 | $6800 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $3400 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $3,400 |
| 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 | $18000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $9000 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,000 |
| 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 Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) Health Insurance Plan, 29698MI0541037
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry), 29698MI0541037 Health Insurance Plan, 29698MI0541037
-
Does MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) Health Insurance Plan, 29698MI0541037 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (29698MI0541037) Health Insurance Plan, Variant (29698MI0541037-00) offer Disease Management Programs?
Does (29698MI0541037) Health Insurance Plan, Variant (29698MI0541037-00) have Out Of Country Coverage?
Does (29698MI0541037) Health Insurance Plan, Variant (29698MI0541037-00) have Out of Service Area Coverage?
Does (29698MI0541037) Health Insurance Plan, Variant (29698MI0541037-00) offer Disease Management Programs?
Does MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) Health Insurance Plan, Variant (29698MI0541037-00) offer Disease Management Programs for Asthma?
Does MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) Health Insurance Plan, Variant (29698MI0541037-00) offer Disease Management Programs for Heart disease?
Does MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) Health Insurance Plan, Variant (29698MI0541037-00) offer Disease Management Programs for Depression?
Does MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) Health Insurance Plan, Variant (29698MI0541037-00) offer Disease Management Programs for Diabetes?
Does MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) Health Insurance Plan, Variant (29698MI0541037-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Does MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) Health Insurance Plan, Variant (29698MI0541037-00) offer Disease Management Programs for Low back pain?
Does MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) Health Insurance Plan, Variant (29698MI0541037-00) offer Disease Management Programs for Pregnancy?
Does MyPriority Balanced Silver Corewell Health West Michigan Network (Allegan, Barry) Health Insurance Plan, Variant (29698MI0541037-00) offer Disease Management Programs for Weight loss programs?
Disclaimer: This is based on the import(Date: Tue, 04 Nov 2025 05:30 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