It will not pay for visits to doctors or hospitals outside its system, except in emergencies. It is a network of physicians and hospitals, but members may choose services inside or outside the network. Within the plan, the cost to the patient for services is relatively small. Outside the plan, patients often pay 20 percent of the covered expense and are likely to have a yearly deductible. It combines features of HMO's and PPO's.
Patients have access to any doctors or services within the network.
If they choose to go outside the network to see a physician, they must pay for a larger portion of such services. POSs will also cover preventative services. Also, the insurance company cannot make you prove insurability or make you face a pre-existing condition exclusion period. These cover the cost of continuing to treat a disabling illness for a specific period of time, usually one year, if you lose your medical coverage. The medical costs of your continued treatment are covered and you do not pay a premium during this period.