POS Plan

Medical House Staff members can select the POS Plan for medical coverage.

About the POS Plan

With the POS Plan, you pay with copays for some services (copays are fixed fee amounts that you pay at the time you receive services).

The Plan also uses coinsurance for some services (coinsurance is the portion of expense you must pay for care, in most cases, after meeting your deductible). The deductible is a set amount that typically you must pay before coinsurance starts.

The POS Plan allows you to receive services from a national network of providers and facilities. It is an open access plan that:

Provides the flexibility to choose any provider
Does not require that a Primary Care Physician (PCP) be identified or selected
Does not require a PCP referral to see a specialist

You have the option of enrolling in a Healthcare Flexible Spending Account (FSA) which allows you to set aside up to $2,850 pre-tax dollars to help pay for medical expenses.

Deductible

All eligible expenses incurred by you or your covered dependents throughout the plan year apply towards meeting the annual deductible.

The Tier 1 deductible is $850 (Employee Only) or $2,550 (Employee + Spouse, Employee + Children, or Family).
The Tier 2 deductible is $1,000 (Employee Only) or $3,000 (Employee + Spouse, Employee + Children, or Family).
The Tier 3 deductible is $2,000 (Employee Only) or $6,000 (Employee + Spouse, Employee + Children, or Family).

The annual deductible must be satisfied before any plan expenses are paid by coinsurance, with the exception of preventive care and Tier Zero prescriptions which are covered at 100%.

The deductible for the POS Plan typically applies to medical services other than office visits, and does not apply to prescriptions.

Coinsurance

Tier 1 and Tier 2 preventive care is covered at 100% and is not subject to the deductible. For all other medical services, the POS Plan pays a portion of your covered expenses after you pay the annual deductible:

Tier 1 care is covered at 85% (you pay 15%)
Tier 2 care is covered at 75% (you pay 25%)
Tier 3 care is covered at 50% (you pay 50%)

Office visits are covered with a copayment. Prescription drugs are covered through coinsurance.

Out-of-Pocket Maximum

The POS Plan has an out-of-pocket maximum to protect you in the event you have significant medical expenses during the year. The out-of-pocket maximum includes all copays, as well as deductible and coinsurances, such as prescription drug costs and office visit copays.

The Tier 1 out-of-pocket maximum is $3,000 (Employee Only) or $6,000 (Employee + Spouse, Employee + Children, or Family).
The Tier 2 out-of-pocket maximum is $4,500 (Employee Only) or $9,000 (Employee + Spouse, Employee + Children, or Family).
The Tier 3 out-of-pocket maximum is $11,250 (Employee Only) or $22,500 (Employee + Spouse, Employee + Children, or Family).