Preferred & alternate benefits comparison

Under PriorityPOS^SM, your employees have the option of choosing 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 copayments. 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 network of over 12,000 health care providers and 125 hospitals.
• 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 copayment.
• 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 copayment, 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.