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What Is Point Of Service Insurance Plans

A Point of Service (POS) plan has some of the qualities of HMO and PPO plans with benefit levels varying depending on whether you receive your care in or out of the health insurance company’s network of providers.

Point of Service (POS) Plans

POS health insurance plans are a hybrid of HMOs and PPOs. With a POS plan, you will have to designate a primary care physician for regular check-ups and referrals. But you can also use out-of-network providers if you are willing to pay more out of pocket; you will usually have a copayment and deductible as well. This kind of plan is versatile and can be right for persons who are willing to pay a bit more for extra flexibility.

How a Point-of-Service Plan (POS) Works

Like an HMO plan, you may be required to designate a primary care physician who will then make referrals to network specialists when required. Depending upon the plan, services rendered by your PCP are typically not subject to a deductible, and preventive care benefits are usually incorporated. Like a PPO plan, you may receive care from non-network providers but with higher out-of-pocket costs. You may also be in charge of copayments, coinsurance, and an annual deductible.

Nevertheless, the POS plan will pay more toward an out-of-network service if the primary care doctor refers to it than if the policyholder goes outside the network without a referral. Premiums for a POS plan fall in between the lower premiums provided by an HMO and the higher premiums of a preferred provider organization.

POS plans necessitate the policyholder to make copayments, but in-network copayments are often just $10 to $25 per appointment. POS plans also do not have deductibles for in-network services, which is an important advantage over PPOs.

POS plans provide nationwide coverage, which benefits patients who travel frequently. A shortcoming is that out-of-network deductibles tend to be high for POS plans. When a deductible is high, it means patients who utilize out-of-network services will pay the full cost of care out of pocket until they reach the plan’s deductible. A patient who never employs a POS plan’s out-of-network services would probably be better off with an HMO due to its lower premiums.

A POS Plan May Be Appropriate for You If:

• You are willing to play by the rules and possibly coordinate your care through a primary care doctor.
• Your chosen doctor already participates in the network.

Resources and References:

• Out-of-Pocket Expenses