However, you do not have to seek treatment from participating facilities or providers. If you need to see a specialist and you go through your PCP to secure a referral, there are definite financial benefits. In considering POS coverage, it is important to determine any coverage limitations of the POS plan being offered at your location. Please call the HMO's Member Services Department for information on the appropriate procedure to follow for approval of these services. You should contact the appropriate Member Services Office for specific details regarding the HMO coverage.
Coverage is provided world-wide for health threatening emergencies.
A health threatening emergency is a sudden, unexpected illness or injury which could reasonable be expected to result in permanent physical impairment or loss of life if not treated immediately. Some examples include heart attack, loss of consciousness, sudden difficulty breathing, poisoning, drug overdose, or uncontrollable bleeding. In these circumstances go immediately to the nearest hospital emergency room. Within 24 hours you must contact your PCP to ensure that the services and follow-up care will be covered. Contact the Member Services Office for complete details.