Maryland Point of Service (POS)

Note: The information below briefly describes important features about this health care program. It is not a contract. A detailed description of benefits is included in the Evidence of Coverage. Please refer to the Evidence of Coverage for specific terms, conditions, limitations and exclusions.

Maryland Point of Service (POS) offers the best of managed care and traditional indemnity coverage in a single plan. The plan includes in- and out-of-network benefits. This plan is only available to groups.

Plan Features:

  • POS members select a Primary Care Physician (PCP) at time of enrollment.
  • Receive the highest level of benefits when receiving care from Primary Care Physician (PCP), or as a result of a referral by the PCP.
  • Many services do not require a PCP referral to obtain in-network benefits.
  • Receive care outside of the network, from any provider, but pay a higher out-of-pocket cost.

Advantages:

  • No referral needed for OB/GYN care, if you choose a preferred provider.
  • No claim forms to file when using PCP or any participating provider.
  • Statewide network of credentialed primary care physicians.
  • More than 18,000 participating providers across the state.

Preventive Care:

  • No-cost preventive services for children and adults
  • Well-child care, including immunizations
  • Routine gynecological care
  • Routine adult physicals
  • Chlamydia screening
  • Prostate cancer screening
  • Mammography
  • Audio screening for newborns
  • Osteoporosis prevention and treatment
  • Colon cancer screening

Medical Benefits:

  • Inpatient hospital care
  • Emergency care
  • Maternity care
  • Diagnostic tests and X-rays
  • Physical therapy
  • Home care and hospice care
  • Surgery
  • Doctor's office visits for illness

3-Tier Prescription Drug Plan:

  • Tier 1 - Generic copays offer the lowest cost to the member $
  • Tier 2 - Copays for formulary/preferred brand name drugs are higher than for generic drugs $$
  • Tier 3 - Copays for nonformulary/nonpreferred brand name drugs have the highest level of copay $$$

Plans typically have some member out-of-pocket costs in the form of copayments, coinsurance, deductibles or annual maximums. Please refer;to the Evidence of Coverage;for more information.

Dental and Vision Coverage May Be Purchased Separately:

Dental Plans:

  • Traditional Dental
  • Preferred (PPO) Dental

Vision Plan:

  • BlueVision Plus

Frequently Asked Questions:

  • Get answers to Frequently Asked Questions regarding this plan.

For more information about this plan, contact our Member Services Department at the phone number on your member ID card.