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.