Point-of-Service (POS) Plans You want more choices. POS health plans allow you to see high-quality in-network and out-of-network providers, with a full range of health care services.
POS PLANS OFFER:
FREE PREVENTATIVE CARE. 100% coverage for preventive services, such as annual exams, screenings, and more, when performed in-network and coded as preventive. $0 COPAY PREVENTIVE DRUGS. There is no cost associated with select preventive drugs that target common medical conditions, such as high blood pressure and diabetes. AFFORDABLE ACCESS TO ASPIRUS NETWORK PROVIDERS. Convenient access to Aspirus Health Plan's Signature Network plus many health care professionals and hospitals in your area. First Health functions as a wrap network to help lower out-of-pocket costs for emergency services in the 49 states outside of Wisconsin.
With a POS plan, it is recommended that you choose a primary care practitioner (PCP) who will help coordinate overall medical care. Unlike an HMO, POS plans give you the option to see other providers without a referral at an additional cost. Some services will require review and prior authorization.
If you seek care from an out-of-network provider, the non-participating reimbursement value will apply to out-of-network providers and services. The amount the plan pays is the allowed amount for any covered service. But if an out-of-network provider charges more than the allowed amount, you may have to pay the difference.
Here's an example: You go to an out-of-network hospital, which charges $1,500 for an overnight stay. If the allowed amount is $1,000, you may have to pay the $500 difference.