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 prior 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.

Prior 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 prior authorization is submitted. The member’s PCP or participating specialist must submit the prior 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.