Saint Mary's HealthFirst

Point of Service Plan

Our HMO.
This benefit level offers low out-of-pocket expenses with no lifetime maximum for your medical services. When you use Saint Mary's HMO, your Primary Care Physician (PCP) is responsible for providing, arranging for, and coordinating all of your medical needs.

Your PCP will also provide referrals for specialized care that may be required. When your PCP provides or refers services, you don't have to keep track of a deductible, coinsurance or claim forms. You simply make a small copayment for each visit.

To select your Primary Care Physician, just review the list of participating providers in the HealthFirst HMO Provider Directory. For more information on our HMO program, please consult our HealthFirst information brochure and Summary of Benefits.

Our PPO.
Should you want to receive care from Preferred Health Care Network (PHCN) providers --- we have more than 1,500 statewide--- you can do so without a referral from your Primary Care Physician.

To visit your PHCN physician you simply pay a slightly higher copayment. For other PPO services, you will need to satisfy an annual deductible and appropriate coinsurance percentages.

The combined lifetime maximum benefit for in-and out-of-network medical services is $2 million. Due to the added flexibility in using the PPO benefits, you will have larger out-of-pocket expenses than under the HMO plan. Please refer to the HealthFirst Point of Service (POS) PPO Provider Directory for a complete listing of participating providers. For more information on the deductible and coinsurance amounts, please refer to the PPO Summary of Benefits. Some services are covered under the HMO benefit only.

Out-of network.
With this benefit level, you're free to seek medical services from licensed providers who are not part of Saint Mary's HMO or PHCN. Benefits will be paid at the appropriate coinsurance rates once you've paid your annual deductible.

This is the benefit level that gives you the freedom to choose providers for your care outside of our HMO and PPO lists of physicians, outpatient centers and other providers. Your out-of-pocket expenses under this benefit will be greater than under Saint Mary's HMO and PPO benefits. Some services are covered under the HMO benefit only.

Above all, service.
Our Member Services staff takes pride in making our health plans easy to understand and being responsive to members' needs. We are committed to answering every phone call promptly, following up personally, and most of all, treating you with the courtesy you deserve.

We think you'll find HealthFirst's Point of Service plan offers the best and most flexible health care options. Call your agent/broker, or Saint Mary's HealthFirst Sales at (775) 770-6065. With Saint Mary's HealthFirst, you benefit from a tradition of quality, caring and service.

The health plan that lets you choose
With HealthFirst's Point of Service Plan, you'll have three coverage benefit levels when you need services from a health care provider.

Under our Point of Service Plan, you have the following benefits available throughout the year:

• Convenient and low out-of-pocket expenses of Saint Mary's Health Maintenance Organization (HMO), when you use an authorized provider from the HMO Provider Directory.



• Freedom to visit any PHCN physician without a referral; or;



• Flexibility to use any licensed medical provider, even if that provider isn't on our HMO or PHCN network.



• Some services are covered under the HMO benefit only.