Point of Service Plans (POS Plans)

A POS or Point of Service plan is another type of managed care group health insurance with characteristics of both an HMO and a PPO. There is more flexibility than in the HMO plans and less than in a PPO.

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What is a POS Plan?

In a POS plan, you select a primary care physician from a list of participating providers, like in an HMO. All your medical care is directed by this physician, so he is your “point of service.” This doctor will normally refer you to other in-network physicians if you have a need for a specialist. There is a broad base of medical providers in the network which typically covers a wide geographic area.

How does a POS plan affect me and my family?

You will also have a choice to see out-of-network providers when you need a specialist, like in a PPO plan. Here, however, you will be required to do paperwork yourself and submit claims for reimbursement from the insurance company. The percentage the insurance company pays for out-of-network charges is lower. Most plans require you to go through your primary care physician before you see the out-of-network specialist. If you refer yourself to an out-of-network doctor, the POS plan often pays even less.

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Advantages and Disadvantages of POS Plans

In a POS, you have greater freedom to see out-of-network providers than with an HMO. However, this freedom comes with a price, so that every time you see an out-of-network provider, it costs extra. Your decision about choosing this type of plan may rest on whether this freedom is worth the extra premium price.

There is an emphasis on prevention and health education, similar to that with an HMO, where members are encouraged to participate in programs which lead them to healthier choices and lifestyles.

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