POS coverage under this prefix operates on a tiered system. Tier 1 (in-network with referral) provides the highest coverage. Tier 2 (in-network without referral) provides moderate coverage. Tier 3 (out-of-network) provides the lowest coverage. Verify which tier applies before submitting the claim.
This is a traditional indemnity prefix. Unlike managed care plans (HMO, PPO, EPO), indemnity plans do not use provider networks. There are no referral requirements and no restrictions on which providers the member can see. Submit claims to the payer listed above for reimbursement at the plan's allowed rate.
This prefix is associated with an EPO plan. Exclusive Provider Organization coverage combines elements of HMO and PPO plans: members must stay in-network like an HMO, but can self-refer to specialists like a PPO. Out-of-network services are not covered except for emergencies.
Independent licensee providing commercial, Medicare and Medicaid plans to Rhode Island members.