Comparing preferred & alternate benefits
Under
PriorityPOS
SM, your employees can choose between in-network providers and services at the Preferred Benefit level or out-of-network providers at the Alternate Benefit level. Here is what they experience at each level:
Preferred Benefit features
- Low copays. Some plans may also include a deductible.
- Go to any health care provider in the network without a referral from a PCP.
- Access to our nationwide network
- Employees and dependents can choose their own PCPs. (For example, a woman might choose an OB/GYN who participates as a PCP; a child's PCP may be a pediatrician.)
- Employees can change their PCPs at any time. Changes are effective the first of the following month.
- Fill prescriptions at any pharmacy in our nationwide network for the normal copay.
- Employees can get out-of-network medical services under the Alternate Benefit level, then return to Preferred Benefit at any time by working with their PCPs and our network.
- Some services, such as surgeries, require prior approval from Priority Health before they're scheduled.
Alternate Benefit features
- Employees can direct their own care to doctors who do not participate in the Priority Health network.
- Employees who live outside of our service area can choose doctors that best meet their needs.
- Out-of-pocket costs may be higher, because health care providers outside our network usually charge more than the charges we negotiate with our network.
- Employees and their dependents may also need to meet deductibles, file claims and handle their own surgery precertifications outside our network.
- Out of-pocket costs for provider services will never exceed the percentage stated in the plan Summary of Benefits.
- Fill prescriptions at any pharmacy in our nationwide network for the plan's normal copay, if the plan includes prescription coverage.
- Employees can return to the Preferred Benefit level at any time by going through their PCPs.
- Some services, such as surgeries, require prior approval from Priority Health, and if the employee does not get prior approval from Priority Health, the service may not be covered.
