FAQ: How am I Billed in a POS Plan?

If you are considering choosing a POS or “point or service” plan as a health care policy from your employer, or are opting into one of your own, you may be wondering just how the payments in such a plan work. But in order to understand how the payments work, we must first familiarize ourselves with POS plans in general.

POS Plan Basic Facts

POS plans are a type of managed-care health insurance that provides the freedom for a member to choose their own doctors regardless of their network of care practitioners who are part of the POS family. Because a POS plan is a type of hybrid medical insurance, the billing for the plan is unique to where you are seeking your medical attention.

One portion of the POS plan is similar to an HMO or “health maintenance organization,” where there is a network of doctors, including the members primary physician. When a policyholder seeks medical attention directly through their network, they typically have to pay a small co-payment on the spot before they can even see the doctor. If the in-network doctor authorizes tests and procedures they are typically already covered under the POS plan and nominal fees will become the financial responsibility of the member.

POS Payments

POS plans provide their members with the freedom to seek medical attention outside of the managed-care system. Those charges need to be paid out of pocket by the member at the time they are provided. Then the member must properly complete and submit a claims form. There is often a deductible amount the member has to make, so until the amount is met, members should not expect any type of reimbursement. However, after the deductible is met, members can then expect to receive a partial rebate for their medical care. Both the deductible amounts and the shared medical costs for outside of network care are presented and discussed before a person becomes an official policy holder.

POS plans are also billed monthly for their premium. The premium must be paid in a timely fashion to insure that the health insurance policy for the POS plan remains intact and constant.