Point-of-Service (POS) Plans POS health plans offer more choices than traditional HMO plans. With a POS plan, you have access to high-quality in-network and out-of-network providers who offer 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. $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. Aspirus offers five regional hospitals in Wisconsin, four more in Michigan, 50 clinics, and more than 400 physicians.
With a POS plan, it is recommended that each member 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.