HMO Plan

Summary of Coverage

Medical plans for team members that live in Michigan in the following counties: Allegan, Barry, Berrien, Cass, Ionia, Kent, Lake, Macomb, Mason, Mecosta, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Osceola, Ottawa, Van Buren, Washtenaw or Wayne.


  •  Access to Tier 1 Corewell Health & Tier 2 Priority Health


Medical plans for team members that live in Michigan outside of the counties. Based on where you live, you may not have easy access to Corewell Health locations.


  • Access to Tier 1 AS Corewell Health OR Priority Health


Medical plans for team members that live out of the state of Michigan.


  • Access to Tier 1 AS Corewell Health, Priority Health OR Cigna

Coverage Details
Tier 1:

Network only
Tier 2:

Network only

Annual Deductible

$650 individual

$1,300 family

$2,000 individual

$4,000 family

Coinsurance Max.

(per plan year)

$2,000 individual

$4,000 family

$3,000 individual

$6,000 family

Out-of-Pocket Limit

(per plan year)

$9,100 individual

$18,200 family

$9,100 individual

$18,200 family

Coinsurance

covered at 80%

covered at 70%
Service Costs
Tier 1:

Network only
Tier 2:

Network only

Well Child Exam

no cost

no cost

Routine Adult

Physical Exam

no cost

no cost

Primary Care

Office Visit

$25 copay

$35 copay

Specialist Office Visit

$40 copay

$50 copay

Virtual Care

(medical & behavioral health)

Covered in full.

Covered in full.

Hospital

In/Outpatient

20% coinsurance. Deductible applies.

30% coinsurance. 

Deductible applies.

Emergency

Department

you pay $150

(waived if admitted)

you pay $150

(waived if admitted)

Urgent Care

$55 copay

$65 copay

How your plan pays for care:

You Pay:


Copays or provider bills until you reach the deductible.


  • If a service does not have copay, such as hospitalization, you pay the provider bill.
  • In the HMO plan, each person on the plan can meet an individual deductible. 


You + The Plan Pay:


Coinsurance. After the deductible is paid, you split costs with the plan until you reach your plan's coinsurance maximum for the year.


  • Costs are higher outside of Tier 1 providers: your share of the bill, the deductible, and the out-of-pocket maximum all increase in the Tier 2 network.
  • The coinsurance maximum is the limit of most of your costs. Copayments are limited by the higher out-of-pocket limit, which is rarely a factor.


The Plan Pays:


Most costs above the coinsurance maximum. The plan covers 100% of eligible costs (such as coinsurance) for the rest of the year.


  • Under the HMO plan, each person on the plan can meet their individual coinsurance maximum.