POS health plans allow you to see high-quality in-network and out-of-network providers, with a full range of health care services. No matter which POS plan you choose, you will receive:
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.
2023 Plan Details – Contracts, Plan Summaries and Summary of Benefits and Coverage (SBCs).
Individual deductible
In network
$1,500 or $2,100 or $2,600
Out of network
$2,300 or $4,200 or $5,200
Individual out-of-pocket maximum
In network
$6,800 or $8,000 or $4,600
Out of network
$12,300 or $14,200 or $15,200
Family deductible
In network
$3,000 or $4,200 or $5,200
Out of network
$4,600 or $8,400 or $10,400
Family out-of-pocket maximum
In network
$13,600 or $16,000 or $9,200
Out of network
$24,600 or $28,400 or $30,400
Coinsurance
In network 20%
Out of network 50%
Office visits
$0 – $35, $70 Specialty
Individual deductible
In network $3,700 or $4,500
Out of network $7,400 or $9,000
Individual out-of-pocket maximum
In network $8,650 or $9,050
Out of network $17,400 or $17,000
Family deductible
In network $7,400 or $9,000
Out of network $14,800 or $18,000
Family out-of-pocket maximum
In network $17,300 or $18,100
Out of network $34,800 or $34,000
Coinsurance
In network 20% or 10%
Out of network 50% or 40%
Office visits
$0 – $45, $90 Specialty
Individual deductible
In network $2,600
Out of network $5,200
Individual out-of-pocket maximum
In network $2,600
Out of network $11,200
Family deductible
In network $5,200
Out of network $10,400
Family out-of-pocket maximum
In network $5,200
Out of network $22,400
Coinsurance
In network 0%
Out of network 30%
Office visits
Deductible and coinsurance
Individual deductible
In network
$3,250 or $4,050 or $5,000
Out of network
$6,500 or $8,100 or $10,000
Individual out-of-pocket maximum
In network
$7,450 or $5,050 or $5,000
Out of network
$16,500 or $18,100 or $16,000
Family deductible
In network
$6,500 or $8,100 or $10,000
Out of network
$13,000 or $16,200 or $20,000
Family out-of-pocket maximum
In network
$14,900 or $10,100 or $10,000
Out of network
$33,000 or $36,200 or $32,000
Coinsurance
In network
20% or 20% or 0%
Out of network
50% or 50% or 30%
Office visits
Deductible and coinsurance
Individual deductible
In network $6,000 or $7,000
Out of network $12,000 or $14,000
Individual out-of-pocket maximum
In network $7,000
Out of network $22,000 or $20,000
Family deductible
In network $12,000 or $14,000
Out of network $24,000 or $28,000
Family out-of-pocket maximum
In network $14,000
Out of network $44,000 or $40,000
Coinsurance
In network 30% or 0%
Out of network 50% or 30%
Office visits
Deductible and coinsurance