POS Plan

The POS Plan works more like a conventional medical plan where members pay co-pays for some services (co-pays are fixed fee amounts that you pay at the time you receive services). The Plan also uses co-insurance for some services (co-insurance is the portion of expense you must pay for care, in most cases, after meeting your deductible).

The deductible is a set amount that typically you must pay before co-insurance starts.

The POS Plan allows members to receive services from a national network of providers and facilities. It is an open access plan that:

With the POS Plan, your monthly/bi-weekly contribution is higher than with the HSA Plan, but your annual deductible is lower (view 2018 medical plan rates). You cannot open a Health Savings Account (HSA) or receive HSA contributions from Emory.

You do have the option of enrolling in a Healthcare Flexible Spending Account (FSA) which allows you to set aside up to $2,550 pre-tax dollars to help pay for medical expenses.

EHN and In-Network preventive care is covered at 100% and is not subject to the deductible. For all other medical services, the plan pays a portion of your covered expenses:

Office visits are covered with a co-payment. Prescription drugs are now covered through co-insurance.

The POS Plan also has an out-of-pocket maximum to protect you in the event you have significant medical expenses during the year. The out-of-pocket maximum includes all co-pays, as well as deductibles and co-insurances, such as prescription drug costs and office visit co-pays.

 

PRESCRIPTION DRUGS

Prescription drug coverage is part of your medical plan and you pay a percentage of the cost though coinsurance. There is also a retail minimum and a retail maximum within a five-tier structure (see chart below). You will pay the co-insurance amount subject to the retail minimum and maximum cost. You do not have to meet your deductible first.

prescription drug chart 2018

 

Prescription drug coverage is administered through CVS/caremark. To determine your coverage tier or cost, call 866-601-6935.

Maintenance Drugs: A maintenance drug is one that is commonly used to treat a chronic or long-term condition and requires regular, daily use. Examples include drugs used to treat high blood pressure, heart disease, asthma and diabetes and birth control. If you take any maintenance prescription medications to treat certain ongoing medical conditions, you will need to fill your 90-day prescriptions in one of three ways: Through CVS/caremark’s mail order service; at a CVS retail pharmacy location; or at an Emory pharmacy. If you attempt to fill a maintenance drug at a pharmacy other than CVS or Emory, you will be charged the full retail cost.

Tier Zero: Emory pays 100% and plan participants will pay $0 for drugs listed as Tier Zero.