A POS plan is a managed care program that combines the features of an HMO plan with the freedom to choose. Just like an HMO, you seek care directly from your primary care physician (PCP) who provides and coordinates your care. You also have the ability to seek care directly from any in-network or out-of-network provider without a referral.
The QualChoice High Option POS Plan provides a full range of medical benefits, access to Arkansas’ largest network of highly qualified doctors, hospitals and pharmacies and the freedom to see QualChoice network specialists without a referral.
Under the High Option Point of Service Plan, you can get care from out-of-network providers. It is your responsibility to obtain pre-authorizations for out-of-network services. If you use in-network providers, you will pay less.
We ask that you go to the nearest in-network emergency room when you are in need of emergency care. We define emergency as those health care services provided on a 24-hour/365-days-a-year basis to evaluate and treat medical conditions of a recent onset and severity, leading a prudent lay person, possessing an average knowledge of medicine and health, to believe his or her condition, sickness, or injury is of such a nature where failure to seek immediate medical care could result in: placing the patient's health in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part. If you have to go to an out-of-network facility and need inpatient care you must notify QualChoice as soon as possible or within 48 hours of your stay so that we may attempt to transfer you to an in-network facility.
QualChoice does require notification of your admission if you are admitted to an in- network facility. The network facility will notify us on your behalf. If you are admitted to an out-of- network facility, you are responsible for notifying QualChoice.
You do not need to select a PCP. We encourage you however, to establish a relationship with one as it can help you better manage your health. Your PCP can provide routine care, treat you for illnesses and injuries, or recommend that you see participating providers or specialists, if required. NOTE: The higher specialist copayment will apply if you do not seek care with your PCP for services.
You pay a co-payment at the time of service. The co-payment will vary, depending on where the services are delivered and by whom (e.g. PCP, specialist, inpatient hospital stay, emergency room, outpatient hospital and pharmacy). Please refer to the current plan brochure for co-payment amounts.
My Account Member Portal Your secure, mobile friendly self-service website for health and benefits information. Order an ID card or print a temporary one, check eligibility or claim status, and much more.
If you do not receive your ID card by your effective date, you may use a copy of your Health Benefits Election (SF2809) Form or electronic enrollment (e.g. Employee Express, PostalEase, etc.) confirmation.