Point of Service (POS) Plan

The POS (Point of Service) plan designs are the most popular plans offered by Piedmont Community Health Plan and Piedmont Community HealthCare. The POS plan design allows members a choice of where and how to receive benefits, which ultimately determines their out-of-pocket costs. This is done through two levels of benefits, in-plan and out-of-plan.

Each member is required to select a primary care physician when they enroll. When the member receives covered services directly from their primary care physician or through a referral from their primary care physician, the member receives in-plan benefits. If the member receives covered services from a provider other than their primary care physician without a referral from the primary care physician, they receive out-of-plan benefits. This is a lower level of benefits, which costs the member more out-of-pocket. The member still receives benefits, but they do cost more.

Referrals are not required for emergency and urgent care within the network. However, the member should notify Piedmont or the primary care physician within 48 hours to receive the necessary authorization. If the member is traveling out of the area or has dependent students out of the area, they are covered in the same manner. All routine care must be received from the primary care physician or with a referral to receive in-plan benefits. Female members have direct in-network access to a participating OB/GYN for at least two visits per year without a referral, depending on the specific benefit plan.

The POS plans are offered to all employee groups with at least two full time employees. Individual POS plans are not available.

For more information on the POS plan designs offered through Piedmont Community Health Plan or Piedmont Community HealthCare, contact us at (434) 947-4463. You can also click on POS Frequently Asked Questions for more information.