Individual Health Plans

Individual POS Plans

A Point of Service Plan, or POS, is a type of managed care plan that allows members to use both in-network and out-of-network providers for their health care. Benefits for covered services received from out-of-network providers are usually lower than benefits for services received from in-network providers. All services, whether in or out of network, are subject to review and some require pre-authorization. If the service is not covered—i.e., excluded, experimental, not medically necessary, etc.—you may not receive benefits. Please check your policy for details.

In-network coverage
Arise Health Plan encourages members to select a Primary Care Practitioner (PCP) to coordinate their overall medical care. A PCP is an in-network provider who practices family medicine, internal medicine, pediatrics, general practice, or obstetrics/gynecology.

Out-of-network coverage
If a member prefers to seek treatment from an out-of-network provider, the member may see that provider for covered services (as indicated in the policy) without our approval at an additional cost (usually a higher coinsurance and/or deductible) to the member.

Pre-service authorizations
If a member requires health care services from an out-of-network provider and there are no in-network providers who can provide those services, that member may still get in-network benefits if a pre-service authorization is submitted. The member’s PCP or participating specialist must submit the pre-service authorization to Arise Health Plan before the member seeks services from the out-of-network provider in order for those services to be considered for payment at the same level as an in-network provider.