POS Plan

The POS Plan offers a large network of providers and gives the freedom to use in-network and out-of-network providers as needed. Coverage is provided through UnitedHealthcare.

POS Plan

Although services are covered both in- and out-of-network, your benefits are greater when you choose in-network providers.
Benefit Tip: When you choose to use providers in the MIHS Network, you will receive lower cost services and therefore, maximize your benefits.

 

POS Plan
MIHS NetworkIn-Network (UHC Choice Plus)
Out-of-Network*
Plan Year Deductible (PYD)
Individual
$750
$1,000
$3,500
Family
$1,500
$2,000
$7,000
Plan Year Out-of-Pocket Maximum (Includes plan deductible and copays)
Individual
$3,250
$4,500
Unlimited
Family
$6,500
$9,000
Unlimited
Office Visits
Preventive Services**
100%
Covered at 100%
Not Covered
Primary Care Physician Office Visit
$25 copay
$40 copay
50% after PYD*
Specialist Physician Office Visit
$50 copay
$70 copay
50% after PYD*
7th Avenue Walk-in Clinic
$25 copay
N/A
N/A
Urgent Care Visit
N/A
$75 copay
$75 copay
Emergency Room Visit
$250 copay (waived if admitted)
Physician Services
In / Outpatient Physician Services DMG Physician Services
20% after PYD
20% after PYD
50% after PYD
Inpatient Hospital Services - Excludes all Physician Charges
Room & Board
Covered at 100%
$750 copay + PYD then 20%
50% after PYD
Outpatient Facility Services - Excludes all Physician Charges
Operating, Recovery & Procedure Rooms Treatment Room; Anesthesia
Covered at 100%
$500 copay + PYD then 20%
50% after PYD
Physical, Occupational, Speech, and Respiratory Therapy (60-visit maximum for all combined services)
Covered at 100%
$70 copay
50% after PYD
Additional Details
Lab and Radiology/X-ray
Covered at 100%
20% after PYD
50% after PYD
Advanced Radiological Imaging
Covered at 100%
$100 copay + PYD then 20%
50% after PYD
Primary Care Physician Recommended
No
Yes
No
* Out-of-Network provider charges are subject to Reasonable & Customary (R&C) plan limits, which may be less than the provider’s actual charge. Members are fully responsible for all charges above R&C limits.
** Claims must be coded by the provider as routine, preventive care. Copays will not be waived for diagnostic services rendered. Note:  Only covered if authorization received through UMR Care Management. Dialysis covered in-network only.