| Note: The information below briefly describes important features about this health care program. It is not a contract. A detailed description of benefits is included in the Evidence of Coverage. Please refer to the Evidence of Coverage for specific terms, conditions, limitations and exclusions. |
Maryland Point of Service (POS) offers the best of managed care and traditional indemnity coverage in a single plan. The plan includes in- and out-of-network benefits. This plan is only available to groups.
Plan Features:
- POS members select a Primary Care Physician (PCP) at time of enrollment.
- Receive the highest level of benefits when receiving care from Primary Care Physician (PCP), or as a result of a referral by the PCP.
- Many services do not require a PCP referral to obtain in-network benefits.
- Receive care outside of the network, from any provider, but pay a higher out-of-pocket cost.
Advantages:
- No referral needed for OB/GYN care, if you choose a preferred provider.
- No claim forms to file when using PCP or any participating provider.
- Statewide network of credentialed primary care physicians.
- More than 18,000 participating providers across the state.
Preventive Care:
- Well-child care, including immunizations
- Routine gynecological care
- Routine adult physicals
- Chlamydia screening
- Prostate cancer screening
- Mammography
- Audio screening for newborns
- Osteoporosis prevention and treatment
- Colon cancer screening
Medical Benefits:
- Inpatient hospital care
- Emergency care
- Maternity care
- Diagnostic tests and X-rays
- Physical therapy
- Home care and hospice care
- Surgery
- Doctor's office visits for illness
3-Tier Prescription Drug Plan:
- Tier 1 - Generic copays offer the lowest cost to the member
- Tier 2 - Copays for formulary/preferred brand name drugs are higher than for generic drugs
- Tier 3 - Copays for nonformulary/nonpreferred brand name drugs have the highest level of copay
Plans typically have some member out-of-pocket costs in the form of copayments, coinsurance, deductibles or annual maximums. Please refer to the Evidence of Coverage for more information.
Dental and Vision Coverage May Be Purchased Separately:
Frequently Asked Questions:
- Click here to get answers to Frequently Asked Questions regarding this plan.
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