Health Maintenance Organization (HMO) and HMO Point of

110.3 – Health Maintenance Organization (HMO) and HMO Point of Service (POS) Coverage and Access (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) HMOs restrict the network of providers from which a beneficiary can receive non- urgent/emergent covered services. HMOs furnish in-network services only. To ease restrictions on access to out-of-network providers, however, an HMO may offer a point of service (POS) benefit option. The following rules apply to an HMOPOS: • Enrollees are allowed the option of receiving specified services outside of the plan's provider network; • An HMOPOS may require enrollees to incur increased cost-sharing for POS services; • An HMOPOS benefit option may limit out-of-network coverage to a specific service or services, and may also limit the dollar amount of coverage that will be provided; and • The HMOPOS option may be offered as a mandatory supplemental benefit or as an optional supplemental benefit. For more information about the POS benefit option for an HMO, see section 30.3 above.