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Plan Details

Network PPO
Metal Tier Silver
Monthly premium Get Quote
Annual Deductible - Individual $2,000.00
Annual Deductible - Family $4,000.00
Coinsurance 20%
Out-of-pocket Limit - Individual (adjust) $6,000.00
Out-of-pocket Limit - Family (adjust) $12,000.00
Primary Doctor Office Visit $30 copay
Specialist $50 copay
Urgent Care $65 copay

How much do I pay for medical services before this plan starts contributing too?

The plan deductible is $2,000.00 Individual / $4,000.00 Family. This means that you would need to spend $2,000.00 / $4,000.00 in medical services, like lab work and outpatient surgery.

Once I've paid my deductible, how much do I pay and how much does HAP pay?

The plan coinsurance is 20%. So if you had an outpatient surgery that cost $1,000, you would pay $200.00 of that cost. HAP would pick up the rest.

What is the most I will have to pay out-of-pocket?

All of your copays, deductible and coinsurance payments roll up to your out-of-pocket limit. So for an individual the most you would have to pay is $6,000.00 and for a family the most you would have to pay is $12,000.00

Preventive Care Coverage

Preventive care coverage is an Essential Health Benefit and fully covered in all of HAPs plans. Preventive care visits like a yearly physical or a yearly visit to the OB/GYN are always free.

Periodic Health Exam/Immunizations Covered
Well Baby Care Covered
Routine Eye Exam Covered
Routine Hearing Exams Covered
Preventive Related Lab Tests and X-rays Covered
Periodic OB/GYN Covered
Hospital Services Coverage
Outpatient Lab/X-Ray $30 copay
Outpatient Surgery Subject to deductible and coinsurance
Emergency Room $200 copay
Inpatient Services Subject to deductible and coinsurance
Maternity Coverage
Prenatal Office Visit Covered
Postnatal Office Visit $50 copay
Labor and Delivery Subject to deductible and coinsurance
Additional Coverage
Mental Health - Outpatient $30 copay
Substance Abuse - Outpatient $30 copay
Vision Coverage

No need to worry, HAP has our member's vision benefits covered! Adult vision hardware is covered along with pediatric vision hardware in all 2014 HAP health plans. Pediatric vision care is an Essential Health Benefit. Pediatric is defined as those members under 19 years of age.

Included vision benefits

  • One pair of eyeglasses every calendar year
  • One pair of lenses every calendar year
  • Contact lenses once every calendar year instead of eyeglasses
  • Wide selection of collection frames and collection contact lenses

Prescription Coverage

Generic Copay $20.00
Preferred Brand Copay $60.00
Non Preferred Brand Copay 50%
Specialty Copay 50%
Out of Network Coverage
Annual Deductible - Individual $4,000.00
Annual Deductible - Family $8,000.00
Coinsurance 50%
Out-of-pocket Limit - Individual $12,000.00
Out-of-pocket Limit - Family $24,000.00
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Pricing Disclaimer
This rating model has been designed to provide an estimate of rates for Individual HMO and PPO Plans. Rates are based on a base rate, benchmark plan factor, age band rate factor, tobacco factor, and geographic factor. The premium rates displayed are intended for existing business administrative changes only based on the current census information submitted. If this information changes before the desired effective date requested, these rates will no longer apply. Final rates are based on the birthdate at the time the policy becomes effective . The estimated rate is provided for informational purposes only and is not a final determination. Actual rates may vary due to rounding. Applicable taxes are embedded in rate.

Please contact HAP Sales for additional pricing information.
* Health Alliance Plan of Michigan received the highest numerical score among commercial health plans in Michigan in the proprietary J.D. Power 2008-2014 U.S. Member Health Plan StudiesSM. 2014 study based on 34,315 total member responses, measuring four plans in Michigan (excludes Medicare and Medicaid). Proprietary study results are based on experiences and perceptions of members surveyed December 2013 – January 2014. Your experiences may vary. Visit jdpower.com