HMO plans that fit your lifestyle
An HMO gives your emoloyees access to doctors and hospitals within its network. A primary care practitioner (PCP) can help coordinate your overall medical care. No matter which HMO plan you choose you will receive:
- 100% coverage for preventive services, such as annual exams and screenings
- $0 copay on preventive drugs that target common medical conditions
- Access to our 24/7/365 online clinic, MDLIVE
- Comprehensive care coordination
- FREE Nurseline 24/7/365
- Access to Hear in America hearing plans
- Tobacco Cessation
Aspirus Health Plans Signature Network
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.
POS Silver
Individual deductible
In network - $7,500
Out of network - $15,000
Individual out-of-pocket maximum
In network - $8,500
Out of network - $25,000
Family deductible
In network - $15,000
Out of network - $30,000
Family out-of-pocket maximum
In network - $17,000
Out of network - $50,000
Coinsurance
In network - 30%
Out of network - 50%
Office visits
$0 – $35, $70 Specialty
POS Bronze
Individual deductible
In network - $6,000
Out of network - $12,000
Individual out-of-pocket maximum
In network - $6,950
Out of network - $22,000
Family deductible
In network - $12,000
Out of network - $24,000
Family out-of-pocket maximum
In network - $13,900
Out of network - $44,000
Coinsurance
In network - 30%
Out of network - 50%
Office visits
30% after deductible