Individual and Family
Point-of-Service (POS) Plans

Point-of-Service (POS) offer 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. No matter which POS plan you choose you will receive:

• 100% coverage for preventive services completed by an in-network provider
• $0 copay on preventive drugs that target common medical conditions
• 24/7/365 video visits for general medical, dermatology and behavioral health through MDLive
• Access to our RN Comprehensive Care Coordination team
• FREE Nurseline 24/7/365
• Access to Hear in America hearing plans
• Tobacco Cessation coverage

Is my doctor in the network?

Aspirus offers 13 regional hospitals in Wisconsin and 4 more in the Upper Peninsula of Michigan, over 75 clinics and more than 400 physicians.

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.