Point of Service (POS)
BlueChoice is a point of service (POS) plan offered by Health Advantage. It offers
all of the benefits of a traditional HMO, with the added freedom to choose out-of-network
services, if the member desires, at an added cost. Under a traditional HMO plan,
the member usually pays 100 percent of any out-of-network charges. Under BlueChoice,
the member has the option of paying a deductible and/or coinsurance for out-of-network
services, plus any balance billing by the provider for charges above the Health
Advantage determined allowance. Presently BlueChoice POS is offered to employer
groups only; individual coverage plans are not available.
Just as in a traditional HMO, members enrolled in BlueChoice choose a primary care
physician (PCP) to coordinate their care. However, when members are seeking medical
care, they may visit their designated PCP for the highest benefit option; or they
may choose to visit another physician in the network or even outside the network
and pay increased out-of-pocket expenses.
BlueChoice members may reduce out-of-pocket expenses by using providers within the
network of more than 5,000 health professionals and 92 hospitals. (Go to the
Provider Directory for a complete list.)
With BlueChoice POS, you have plan choices that include comprehensive coverage,
hassle-free claims processing and benefits that focus on keeping you healthy. Some
of our standard features are:
- No in-network deductible
- Preventive health services
- Well-baby care
- Free immunizations
- Routine eye exams
- Wellness discounts
- Freedom to choose the out-of-network option
- Optional prescription drug coverage
All Health Advantage health plans provided to employers with 50 or fewer employees
include a POS option. Health Advantage offers health plans without the POS option
to employers with more than 50 employees, but only if the employer has an alternative
health benefit plan that gives its employees the ability to elect (at least annually)
to receive benefits for health services from "out-of-network providers."
For More Information:
Call: Group Marketing, 501-379-4644 or 1-800-605-8301 (toll free)
E-mail: Customer
Service
Open Access Point of Service (POS)
In response to customer requests for direct access to network providers and a lower-priced
health plan, Health Advantage offers a product called Open Access Point of Service
(Open Access POS).
Combination Plan
Open Access POS is an innovative plan that combines the characteristics of traditional
health maintenance organization (HMO) coverage with the extra provider options of
a point-of-service (POS) plan. Like an HMO, Open Access POS provides preventive
and routine services and requires copayments for visits to primary care physicians
(PCPs). However, Open Access POS members may visit in-network specialty physicians
without a PCP referral (PCP selection is recommended but not required). The member
controls costs by choosing the level of deductibles, copayments and coinsurance
for specialty and hospital services.
What Is Open Access?
Open Access means that members have choices when visiting health-care providers
and in using their Health Advantage benefits. Open Access gives members the ability
to visit any in-network provider without going through a PCP for a referral and
receive the highest level of benefits available under the in-network benefit program.
Members also have the option of using out-of-network providers and receiving the
out-of-network benefit coverage.
Plan Offerings
- In-network deductible: Options include no deductible, $250, $500 or $1,000
in-network deductible. The in-network deductible applies to specialty services,
hospital, maternity, rehabilitation, home health and skilled nursing facility services.
This deductible applies after the member pays the applicable copayment.
- Copayments: These vary depending on service. Standard physician copayment
options are $25 or $35. The inpatient admission copayment ranges from no copayment
to $500. The outpatient facility copayment is $100 for outpatient surgery. Benefit
determination requires that copayments are always subtracted first, followed by
the deductible and coinsurance.
- Preventive Services: Primary-care-physician services are not subject to deductible.
- Emergency Services: The $100 copayment and coinsurance are not subject to
deductible.
- Coinsurance: The in-network options are 10, 20 and 30 percent.
- Out-of-Network: Out-of-network services apply after deductibles. Deductible
options begin at $750.
- Pharmacy: Options include copayments of $7/$30/$50, $10/$30/$50, or
20 percent coinsurance and copayment of $10/$30/$50. Groups with more than
50 employees may select a $10/$20/$30 copayment option.
For More Information:
Call: Group Marketing, 501-379-4644 or 1-800-605-8301 (toll free)
E-mail: Customer
Service
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