The Point of Service Plus (POS Plus) plan offers you the same great benefits as the POS plan, but without a deductible or coinsurance for in-network medical services. You may select this during Open Enrollment, with the plan going into effect January 1, 2016. This plan option is only available to faculty, administrative/professional staff and nonunion support staff.
In-network benefit level – You select a HUGHP network primary care physician who coordinates your care and refers you to a network specialist; services are covered at the in-network benefit level. You also have access to the full Blue Cross Blue Shield of Massachusetts HMO Blue specialist network. When your PCP manages your care, you have the lowest out of pocket cost.
Out-of-network benefit level – You can arrange care without a referral, or choose a provider who does not participate in the Harvard University Group Health Plan network. When you choose to receive care out-of-network, you 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.
- No deductibles or coinsurance for in-network medical care
- The flexibility to choose a primary care physician who coordinates all of your care, or you can arrange care without referrals and/or selecting a provider who does not participate in the Harvard University Group Health Plan network
- $30 copayments for office visits (primary care and specialists); $100 copayment for emergency room visits
- In-network out-of-pocket maximums of $2,000 per individual and $6,000 per family
- Lower out-of-pocket costs for those who want greater predictability at the point of care with a higher premium
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.