Know before you go. The Point-of-Service (POS) benefit offers extra flexibility at added cost.
Your US Family Health Plan is an HMO-type plan that includes two benefit levels: The In-Network benefit level and the Point-of-Service benefit level. It’s very important to understand, in advance, the difference between these benefit levels to avoid unexpected costs.
Your out-of-pocket costs will be much higher if you choose to use your Point-of-Service benefit. Please read the information below before you decide to use this option.
While this benefit can give you greater freedom, you should be sure you understand what your out-of-pocket costs will be before you use this option. You may also want to call Member Services to talk through your options before you seek care from out-of-network providers.
IN-NETWORK: Members generally receive health care from one of the Plan’s contracted network providers—the doctors, health care providers, hospitals, and durable medical equipment (DME) vendors who have agreed to take care of our members at negotiated rates. This care is provided at no or very low costs to members with no deductibles.
POINT-OF-SERVICE (POS): This benefit allows you the flexibility to choose to see an out-of-network (TRICARE®-authorized) provider when the service is available from an in-network provider. You will incur higher costs if you use the Point-of-Service option (see details below). While this benefit can give you greater freedom, you should be sure you understand what your out-of-pocket costs will be before you use this option. If you use your POS benefit, you do not need a referral from your primary care provider (PCP). We still strongly encourage you to have your PCP give you a referral, as they know your health the best and can help you choose the best specialist for your care.
The Point-of-Service benefit does not apply to:
Additionally, Zostavax vaccine, non-emergent ambulance, diagnostic services, dialysis, diagnostic drugs, and sleep studies are not subject to POS.
This is not a comprehensive list; depending on billing, there may be other services that may or may not be covered under your POS benefit.