Point of Service Plan (POS)
Note: applicable to all employee groups other than AAUP and ONA
With Humana's Point of Service (POS) plans, you can reduce your out-of-pocket costs by choosing providers in the network — or you can seek services outside the network and pay more. It's your choice.
When you receive services from in-network providers, the plan covers more of your costs. You have the choice to go outside the network – but you’ll pay more.
You have access to in-network savings with more than 400,000 hospitals, pharmacies, and ancilliary care providers. To find providers in Humana’s Physician Finder Plus, choose “National POS – Open Access” from the network selection drop down menu.
The Plan also pays benefits for covered services from out-of-network providers.
You don’t need to select a Primary Care Physician (PCP), but you are encouraged to develop a relationship with one doctor who can help you make informed health care decisions, be familiar with your complete medical history, and guide you to appropriate specialists.
- Referrals aren’t necessary for out-of-network services.
- You pay a co-pay for office visits and many other services.
The Plan includes a deductible and 90% co-insurance for in-network services. The 2014 in-network deductible is $100 for employee only coverage and $200 for all other levels of coverage. The out-of-network deductible is $400 for employee only coverage and $800 for all other levels of coverage.
In a true emergency, care by an out-of-network provider for a life-threatening illness or accidental injury will be covered at network benefit levels, provided the plan is notified within 48 hours.
Co-insurance is defined as the expense that an insured person is required to pay after the deductible is met. Once the deductible has been satisfied, the plan provides coverage for eligible expenses through co-insurance. The highest levels of coverage under the plan are available by utilizing the Humana network of providers.
If you utilize network providers, the plan pays for 90% of eligible expenses and you are responsible for the remaining 10% until you reach the co-insurance (or out of pocket maximum). If you do not use network providers, the plan pays for 70% of eligible expenses and you are responsible for the remaining 30%.
The same co-insurance level (90% in-network and 70% out-of-network) applies to the Point of Service Plans and the new High Deductible Health Plan (HDHP) beginning in 2014.
The POS Plan provides financial protection for you and your family in the event of a catastrophic illness or injury through the annual out-of-pocket maximum.
If your share of in-network expenses (deductible and co-insurance paid by you) during the calendar reaches $1,100 for employee only coverage and $2,200 for all other levels of coverage, all remaining eligible expenses are covered by the plan at 100%.
|Annual Out-of-Pocket Maximum||In-Network||Out-of-Network|
|Individual (Employee Only) Coverage||$1100*||$1100*|
Family Coverage (any coverage level other than Employee Only)
*includes expenses paid towards the deductible
Humana will continue as the plan’s pharmacy benefit manager for 2014. You may fill prescriptions at either a retail pharmacy or by using RightSource mail order service for maintenance medications.
The Humana prescription drug plan is called Rx4. Prescription medications fall into one of four (4) levels. The copayment corresponds to the level on which the medicine falls. Refer to the POS Medical Plan Comparison Chart for copayment information.
- Level One: Lower cost generic and brand name medicines.
- Level Two: Higher cost generic and brand name medicines.
- Level Three: Higher cost medicines, most brand name medicines. These medicines may have generic or brand name alternatives on Levels One or Two that may save you money. This level also includes some self-administered injectable medicines.
- Level Four: Expensive medicines. This level includes self-administered injectable medicines and high-technology medicines that are often newly approved by the U.S. Food and Drug Administration. Level Four medications require a 25% co-insurance payment at the time of purchase, subject to a $250 per prescription maximum.
Refer to the 2013 Rx4 listing to determine which medicines fall into each level and to identify which medications are considered maintenance medications. This listing will also identify which medications are subject to utilization management requirements (e.g., step therapy, etc.) described on the UC/HR Benefits website.
Maintenance medicine prescriptions must be sent to RightSourceRx, Humana’s prescription home-delivery service.
A 30-day supply of a maintenance medicine may be filled two (2) times at a regular local pharmacy for the regular copayment. After that, if a maintenance medicine is filled at a local pharmacy, the cost will be twice the regular copayment.
Prescriptions for 90-day supplies at retail pharmacies are no longer be available. Read the Humana RightSourceRx brochure for more information.
Additional information is available on the RightSourceRx website