The Point of Service (POS) plan allows you to choose a primary care physician to coordinate all of your care, just like the HMO plan. You have the added flexibility of choosing to arrange care without a referral or selecting a provider who does not participate in the Harvard University Group Health Plan network.
With the POS plan, when a primary care physician coordinates your care and refers you to a network specialist, services are covered at the HMO level. Harvard University Group Health Plan POS members also have access to the full Blue Cross Blue Shield of Massachusetts HMO Blue specialist network.
You can also arrange care without a referral, or choose a provider who does not participate in the Harvard University Group Health Plan network. If you choose this option, you will have higher out-of-pocket costs. Services out-of-network will be reimbursed based on an allowed charge.1 If your out-of-network provider charges more than the allowed amount, you may be billed for the difference. This is called balance billing.
Example: The cost to see an out-of-network provider for an office visit
|Blue Cross pays||$100 (allowed amount)||
Negotiated rate because HUGHP has a contract with the provider
|What you owe:||
$175 (includes the following):
|Your in-network copayment, deductible, or co-insurance|
All dollar amounts in this example are hypothetical and for illustrative purposes only. Note: Even if you’ve met your deductible and out-of-pocket maximum for the year, you are still responsible for balance billing charges.
For specific details about this plan, review the POS Summary of Benefits and Benefit Description documents. Please note, there may be a difference between union and non-union benefits.
1 The “allowed” charge is what Medicare pays for the same service, plus 50 percent. If there is no established Medicare reimbursement rate, HUGHP will base its payment on similar payments for providers in that area.