Point of Service (POS) Plans

The Point of Service (POS) Plans offer participants two types of medical plans in one — a network-based health plan and a traditional fee-for-service plan. However, participants receive a higher level of benefits and pay lower out-of-pocket costs when they use network providers.

POS Plans generally include a prescription drug benefit.

How the POS Plans Work

When a participant uses network providers, he or she, as well as his or her covered dependents, must coordinate their care through a primary care physician (PCP). Each covered person may select his or her own PCP. This PCP will provide all routine medical care and will refer the participant to a network specialist whenever he or she needs specialty care.

If a participant uses an out-of-network provider, then he or she generally must first meet an annual deductible. Then, whenever the participant receives medical services, the POS plan pays a percentage of the cost of services, up to the reasonable and customary limit. The participant pays the remaining percentage (the coinsurance) plus any amount above the reasonable and customary limit.

For more information about how a specific POS works, a participant should refer to his or her evidence of coverage booklet.

Choosing a Primary Care Physician (PCP)

Generally, the participant and each of his or her covered dependents must select a primary care physician (PCP) from the POS's network of providers. Each covered person may select his or her own PCP and each participant can generally change his or her PCP at any time during the year.

To select or change a primary care dentist, participants should call the member services number on the back of their ID card.

What the POS Plans Cover and Do Not Cover

The POS plans generally cover preventive, wellness, emergency, surgical and hospital services.

For a complete list of what is covered and not covered by a POS plan, participants may refer to the POS plan's Evidence of Coverage.