Michigan health plan · 2025

University of Michigan Health Plan HMO Exclusive Silver · 60829MI0190017

Physicians Health Plan offers this marketplace health insurance plan (Plan ID 60829MI0190017) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: HMO CSR: 87% AV Level Silver Plan Issuer: Physicians Health Plan
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 87.62%. Expect to pay roughly 12.38% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 87.50% (12.50% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$280 – $1229

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$3,050

$6100 per group

Review MOOP rules

Office visits

Primary care $20.00
Specialist $40.00
HSA Not eligible

Drug tiers

Generic $15.00
Preferred brand $40.00

View formulary tiers

$399 / mo before subsidies

≈ $4784 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1283 / mo before subsidies

≈ $15394 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1572 / mo before subsidies

≈ $18865 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$969 / mo before subsidies

≈ $11632 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

20.00% Coinsurance after deductible

Durable Medical Equipment

50.00%

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Michigan). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • 87% AV Level Silver Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

20.00% Coinsurance after deductible

Durable Medical Equipment

50.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 60829MI0190017
Coverage year 2025
State Michigan
Issuer Physicians Health Plan
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 60829MI0190017-05
Available variants

Standard Off Exchange Plan · 60829MI0190017-00

Standard On Exchange Plan · 60829MI0190017-01

Open to Indians below 300% FPL · 60829MI0190017-02

Open to Indians above 300% FPL · 60829MI0190017-03

73% AV Silver Plan · 60829MI0190017-04

87% AV Silver Plan · 60829MI0190017-05

94% AV Silver Plan · 60829MI0190017-06
Last plan update Wed, 09 Oct 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Michigan 13451
PCPs in Michigan 2520
Telehealth support Data pending
Nationwide providers 70357
13,451 doctors statewide 2,520 PCPs 89 OB/GYN

Provider network(s)

Providers Michigan All US states
All 13451 70357
PCP 2520 2598
Allergy 13 13
OB/GYN 89 95
Dentists 14 15

Drug coverage overview

6,997 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-BRAND 2,858
MEDICAL-SERVICE-DRUGS 1,615
SPECIALTY-DRUGS 1,395
NON-PREFERRED-SPECIALTY 544
GENERIC 534
NON-PREFERRED-GENERIC 51
Prior authorization Drugs
Required 1,730
Not Required 5,267
Step therapy Drugs
Required 164
Not Required 6,833
Quantity limits Drugs
Has Limit 881
No Limit 6,116

Customer highlights

What stands out for members

  • Issuer: Physicians Health Plan · Plan ID 60829MI0190017 · 2025 filing.
  • Disease management programs available: Asthma, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 60829MI0190017-05 (87% AV Silver Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$30.00 Copay after deductible
Tier 1 in-network $30.00 Copay after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

nan

Exclusions: nan

Diabetes Education

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Home Health Care Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior approval required

Exclusions: nan

Laboratory Outpatient and Professional Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

nan

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

nan

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$40.00 Copay after deductible
Tier 1 in-network $40.00 Copay after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

nan

Exclusions: nan

Rehabilitative Speech Therapy

$40.00 Copay after deductible
Tier 1 in-network $40.00 Copay after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Prior approval required

Exclusions: nan

Specialist Visit

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

nan

Exclusions: nan

Telemedicine Services

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

Cost share applies per benefit category

Exclusions: nan

Urgent Care Centers or Facilities

$50.00
Tier 1 in-network $50.00
Out-of-network $50.00

nan

Exclusions: nan

X-rays and Diagnostic Imaging

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Approval required if stay is longer than federal minimum time frames.

Exclusions: nan

Dialysis

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Certain DME require Prior Auth. Contact PHP

Exclusions: nan

Emergency Room Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

nan

Exclusions: nan

Hospice Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 45.0 Days per Year

Coverage includes inpatient and outpatient hospice care.

Exclusions: Custodial Care

Inpatient Hospital Services (e.g., Hospital Stay)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior approval required

Exclusions: nan

Inpatient Physician and Surgical Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior approval required.

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

Prior approval required for all non-routine services. The cost sharing that displays applies to outpatient office visits and testing only. All other outpatient services, such as, but not limited to, treatment and therapies, may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

$40.00 Copay after deductible
Tier 1 in-network $40.00 Copay after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

PT/OT - combined visits per contract year; 30 ST per contract year; 30 cardiac/pulmonary visits per contract year.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Radiation

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 45.0 Days per Year

Prior approval required

Exclusions: nan

Substance Abuse Disorder Inpatient Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior approval required.

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

Prior approval required for all non-routine services.

Exclusions: nan

Transplant

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Must be done at Designated Facility. Prior approval required.

Exclusions: nan

Mental health & substance use

Behavioral health visits and substance use treatment.

Autism Spectrum Disorders

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior approval required

Exclusions: nan

Mental Health Intermediate

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior approval required

Exclusions: nan

Substance Abuse Intermediate

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior approval required

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

Coverage details pending

nan

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Year

nan

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$15.00
Tier 1 in-network $15.00
Out-of-network 100.00%

nan

Exclusions: nan

Non-Preferred Brand Drugs

$80.00
Tier 1 in-network $80.00
Out-of-network 100.00%

nan

Exclusions: nan

Non-Preferred Specialty Drugs

40.00%
Tier 1 in-network 40.00%
Out-of-network 100.00%

Prior approval required on selected drugs. All specialty drugs are only available in up to 31-day supply from Accredo mail-order specialty pharmacy.

Exclusions: nan

Preferred Brand Drugs

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

nan

Exclusions: nan

Preferred Generic Drugs

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

Tier 1A preferred generic drugs have the lowest copay (see SBC) and are available from a network retail pharmacy in up to a 90-day supply

Exclusions: nan

Specialty Drugs

20.00%
Tier 1 in-network 20.00%
Out-of-network 100.00%

Prior approval required on select drugs. All specialty drugs are only available in up to 31-day supply from Accredo mail-order specialty pharmacy.

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Prior approval required

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Anesthesia

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Prior approval required

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior approval required.

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior approval required

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Prior approval required for some items

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Bariatric Surgery

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Procedure(s) per Lifetime

Prior approval required

Exclusions: nan

Clinical Trials

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior approval required

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

nan

Exclusions: nan

Gender Affirming Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior approval required

Exclusions: nan

Habilitation Services

$40.00 Copay after deductible
Tier 1 in-network $40.00 Copay after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Yearly limits: PT and OT: 30 visits, Speech: 30 visits.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

$150.00 Copay after deductible
Tier 1 in-network $150.00 Copay after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Infertility Treatment

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Underlying causes only.

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior approval required

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 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.

Exclusions: nan

Variant attributes

University of Michigan Health Plan HMO Exclusive Silver · Variant 60829MI0190017-05

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

87% AV Level Silver Plan

HIOS Product ID

60829MI019

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

60829MI0190017-05

Plan Marketing Name

University of Michigan Health Plan HMO Exclusive Silver

Plan Variant Marketing Name

University of Michigan Health Plan HMO Exclusive Silver

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

87.62%

Issuer ID

60829

Issuer Marketplace Marketing Name

University of Michigan Health Plan

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

MIN001

Out of Country Coverage

Yes

Out of Country Coverage Description

Coverage for emergency and urgent care only

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Coverage only for emergency health services and urgent care visits at network benefit level

Service Area ID

MIS003

State Code

MI

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.875007818075503

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

20.00%

SBC Scenario, Having a Baby, Coinsurance

$2,400

SBC Scenario, Having a Baby, Copayment

$10

SBC Scenario, Having a Baby, Deductible

$650

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$1,000

SBC Scenario, Having Diabetes, Deductible

$400

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$400

SBC Scenario, Treatment of a Simple Fracture, Copayment

$200

SBC Scenario, Treatment of a Simple Fracture, Deductible

$650

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

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$6100 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$3050 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$3,050

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

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

MIF011

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$50

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$0

Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Out of Network, Individual

Not Applicable

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Diabetes, 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%

Import Date

2024-10-09 20:01:46

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$1300 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$650 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$650

Medical EHB Deductible, Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Out of Network, Individual

Not Applicable

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

HMO

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

60829MI0190017

Unique Plan Design

Yes

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Michigan?

University of Michigan Health Plan HMO Exclusive Silver (60829MI0190017) is a Silver HMO from Physicians Health Plan in Michigan for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does University of Michigan Health Plan HMO Exclusive Silver support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is University of Michigan Health Plan HMO Exclusive Silver HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does University of Michigan Health Plan HMO Exclusive Silver support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with University of Michigan Health Plan HMO Exclusive Silver?

The issuer lists disease management resources for: Asthma, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.

Is there out-of-country coverage for University of Michigan Health Plan HMO Exclusive Silver?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Coverage for emergency and urgent care only

Does University of Michigan Health Plan HMO Exclusive Silver cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Coverage only for emergency health services and urgent care visits at network benefit level

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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