Out-of-network provider coverage.

Overview

With Humana's Point of Service (POS) plans, you can reduce your out-of-pocket costs by choosing providers in the network – or you can seek services outside the network and pay more. It's your choice.

POS plans can be "traditional" or "consumer-driven."

How it works

Humana has two kinds of POS plans: Regional POS and National POS - Open Access.

Regional POS plans give you access to in-network savings with the HMO providers in your network. The plan also pays benefits for covered services from out-of-network providers. Depending on your employer's plan, you may or may not need a primary care physician.

National POS - Open Access plans cover more of your costs when you go to in-network providers, but you also have the choice to go outside the network. You do not need a primary care physician (PCP).

Plan tools

  • MyHumana tools
  • MyHumana mobile
  • Printable Humana ID card
  • Preauthorization and Notification Lists

How It Works

POS plans combine the advantages of a Health Maintenance Organization (HMO) plan with the flexibility of a Preferred Provider Organization (PPO) plan.

Humana has two kinds of POS plans: Regional POS and National POS - Open Access. Here's how these two types of plans work:

Regional POS

When you receive services from in-network providers, the plan covers more of your costs. You also have the choice to go outside the network – but you'll pay more.

Plan features:

  • You have access to in-network savings with the HMO providers in your network.
  • The plan also pays benefits for covered services from out-of-network providers.
  • Depending on your plan design, you may or may not need a primary care physician (PCP); either way you're encouraged to develop a relationship with one doctor who can help you make informed healthcare decisions, be familiar with your complete medical history, and guide you to appropriate specialists.
  • With most plans, referrals aren't necessary for out-of-network services.
  • Traditional plan designs have copayments for most services.

National POS - Open Access

When you receive services from in-network providers, the plan covers more of your costs. You also have the choice to go outside the network – but you'll pay more.

Plan features:

  • You have access to in-network savings with more than 400,000 doctors, hospitals, pharmacies, and ancillary care providers; to find providers in Physician Finder Plus, choose "National POS - Open Access" or "Humana Preferred POS - Open Access" from the network selection drop-down menu.
  • The plan also pays benefits for covered services from out-of-network providers.
  • You don't need a primary care physician (PCP); you are encouraged to develop a relationship with one doctor who can help you make informed healthcare decisions, be familiar with your complete medical history, and guide you to appropriate specialists.
  • Referrals aren't necessary for out-of-network services.
  • Both traditional plan designs – which have copayments for most services – and consumer-driven plans are available.

Plan Tools

Here are some Humana tools that may be useful to members who have a POS plan.

MyHumana tools

Visit your secure Website on Humana.com to:

  • Find in-network doctors and hospitals for your specific plan
  • Get details about what your plan covers and what you pay for services
  • Check the status of a claim
  • Order a replacement ID card

To access these tools and more, Log in to MyHumana. If you haven't signed up for your secure Website yet, Register for MyHumana today.

MyHumana Mobile

Humana's mobile resources are designed to support the on-the-go needs of consumers and empower healthcare decisions at the point of service. Resources featured in MyHumana Mobile include: an urgent care finder, a spending account balance viewer, and ID card details. Use your existing MyHumana login to access the resources on your mobile device's browser.

Learn more about MyHumana Mobile

Printable Humana ID card

To get printable proof of your Humana coverage, simply fill out the online form in our Humana ID Card Viewer

Humana Commercial Preauthorization and Notification Lists

These dated documents provide a complete list of services that require preauthorization or prior authorization. Some employer groups for which Humana provides administrative services only (self-insured and employer-sponsored programs) may customize their plans with different requirements.

In addition, most HMO plans require approval in advance from your primary care physician before you see a specialist or certain other providers. This is called a "referral." If you don't have a referral before you get services from a specialist, you may have to pay for these services yourself.

January 22, 2011, Commercial Preauthorization and Notification List
(265 KB) Download PDF
English
January 24, 2010, Commercial Preauthorization and Notification List
(97 KB) Download PDF
English
July 10, 2009, Commercial Preauthorization and Notification List
(92 KB) Download PDF
English

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