FAQ: How Do POS Networks Operate?

Posted in Health Insurance , Point of Service Plans

September 28th, 2009

You have chosen a POS health insurance plan because you can get care both from a service network of providers and choose your own physicians as well. POS (point of service plans) are a type of managed care health insurance that acts as a hybrid of an HMO and a traditional health care plan.

POS Network Basics

A POS plan has numerous doctors, hospitals, surgeons and other health practitioners under contract. With this contract, the insurance company can better manage their expenses as can gauge what the actual expense for treating a member will be. Additionally, the POS network encourages preventative medicine such as regular check ups and annual health screens, which encourages their members to follow a healthy lifestyle on their own.

POS Referrals

When a person decides to become a certificate holder of a POS network, they will first have to choose a primary care physician (PCP). This PCP will then become the official liaison between the member and the insurance company. In order for a member to get the most cost-effective health care through their POS network, they need to visit their PCP for basic care (such as check ups), and can see a specialist both in and out of the network when they need to.

POS plan members should visit as many in-network service providers as possible, as that will help control costs. Deductibles are non-existent or extremely low for in-network care and copayments are either waived or run about $10-$25 per visit.

In general, the network portion of a POS managed care health plan operates very similarly to an HMO plan.