Point-of-service plan resources

If you're on a point-of-service plan through your employer, here's everything you need to know. 

Our Point of Service Plan (POS) gives you the coordinated care of an HMO and the flexibility of a PPO. POS members are able to access care in two different ways, called tiers. Tier 1 works like an HMO, and Tier 2 works like a PPO.


 

Tier 1

Your HMO level benefits and care.

When accessing health services through this tier, you get the care you need from doctors and hospitals in Sharp Health Plan’s Choice Network. You’ll be able to choose your own personal doctor — primary care physician, or PCP — who will coordinate all of your care, including referrals to specialists. Any specialists you see will need to be in the same plan medical group as your PCP.


View Choice Hospitals  Find a doctor


Here’s what to remember about Tier 1:

  • Your PCP is your main point of contact for all of your health care needs. They’ll handle your care, coordinate any treatments, refer you to a specialist if you need one, and more.
  • Preventive care services are offered at no extra cost.
  • Copays or coinsurance costs apply for most other care visits and services.

Tier 2

Your out-of-network level benefits and care.

With Tier 2, you can get care from the Aetna Open Choice PPO provider network, as well as out-of-network providers — with no referral needed. It’s important to remember that when you choose to get care from the Aetna Open Choice PPO provider network or out-of-network providers, your out-of-pocket costs will be higher. Out-of-network providers include any U.S. licensed health care professionals and facilities.

Use the tool below to search for an Aetna provider. Be sure to select the Open Choice PPO plan. 


Find an Aetna provider


Here's what to remember about Tier 2:

  • You can make appointments directly with providers in the Aetna Open Choice PPO network, or with any licensed health care providers in the U.S.
  • Copays or coinsurance costs apply to every visit and service, in addition to your deductible.
  • You’ll need to get precertification before you can receive most out-of-network services.

Precertification

Precertification means prior approval from Sharp Health Plan. It’s a good idea to talk to your out-of-network provider before you receive services, to make sure they receive any required precertification from Sharp Health Plan in advance. This will help manage your out-of-pocket costs.


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