Point of Service 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. POS plans can be “traditional” or “consumer-driven.”

How a POS Plan Works

POS plans combine the advantages of a Health Maintenance Organization (HMO) plan with the flexibility of a Preferred Provider Organization (PPO) plan. Humana has two kinds of POS plans:

• Regional POS



• National POS - Open Access

Regional POS

When you receive services from in-network providers, the plan covers more of your costs. You also have the choice to go outside the network – but you’ll pay more.

Plan features:

• You have access to in-network savings with the HMO providers in your network



• The plan also pays benefits for covered services from out-of-network providers



• Depending on your plan design, you may or may not need a primary care physician (PCP); either way you're encouraged to develop a relationship with one doctor who can help you make informed healthcare decisions, be familiar with your complete medical history, and guide you to appropriate specialists



• With most plans, referrals aren’t necessary for out-of-network services



• Traditional plan designs have copayments for most services

National POS - Open Access

When you receive services from in-network providers, the plan covers more of your costs. You also have the choice to go outside the network – but you’ll pay more.

Plan features:

• You have access to in-network savings with more than 400,000 doctors, hospitals, pharmacies, and ancillary care providers; to find providers in Physician Finder Plus, choose "National POS - Open Access" or "Humana Preferred POS - Open Access" from the network selection drop-down menu



• The plan also pays benefits for covered services from out-of-network providers



• You do not need a primary care physician (PCP); you are encouraged to develop a relationship with one doctor who can help you make informed healthcare decisions, be familiar with your complete medical history, and guide you to appropriate specialists



• Referrals aren’t necessary for out-of-network services



• Both traditional plan designs – which have copayments for most services – and consumer-driven plans are available

With a National POS plan, your Certificate of Coverage includes two documents: the HMO certificate reflects the amount you’re responsible for when you receive healthcare services; the PPO certificate shows your plan's responsibility. The plan’s coverage is the same for HMO and PPO network providers.

Traditional and Consumer-Driven Plans

The difference between “traditional” or “consumer-driven” plans is how you pay out-of-pocket costs. Traditional plans usually have copayments and coinsurance. Consumer-driven plans usually have a higher deductible, but they come with a spending account or allowance to help you pay healthcare costs.

Your employer may offer a special type of POS plan called Humana Preferred^SM. Humana Preferred’s network includes a subset of providers – representing all specialties and geographic areas – who have demonstrated cost-effective care. With this type of plan, you also have access to user-friendly transparency tools that display provider effectiveness and cost information.