Point of Service Plans Current Rates, News & Information

FAQ: How Do POS Networks Operate?

Posted in Health Insurance , Point of Service Plans

September 28th, 2009
No Comments

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.

FAQ: How Do Referrals Work in a POS Plan?

Posted in Health Insurance , Point of Service Plans

September 25th, 2009
No Comments

POS plans are a type of managed care health plan that grants policyholders the ability to see both in and out of network practitioners. Within a managed care health insurance system there is a system of doctors, hospitals and health practitioners under contractual obligation through the insurance provider. When an individual chooses to sign up for managed care, the first thing they will need to do is choose a primary care physician (PCP). With a POS plan, the member can see both doctors within the service network and outside of the policy. If the member has a condition for which they want to go outside of the service network for treatment, they still must get a referral from their PCP.

Primary Care Physicians

PCPs act as the gatekeepers for POS plans. To help manage the overall cost to the insurance companies, the PCPs are really the first line of defense to ensure that any additional treatment by a specialist is actually necessary. The member must first see the PCP, discuss their condition, and the PCP will then work closely with them to decide the most beneficial path for treatment including making the necessary referrals for the POS plan to contribute to the expenses.

Many POS plans also pay coinsurance for those appointments that are considered a “self-referral.” Self-referral is when the patient opts to visit a doctor outside of the service network system without getting authorization from their PCP. When this occurs, typically the rate of coinsurance contribution the medical insurance will kick in is a lower percentage than if someone follows the proper POS referral steps.

Point of Service Plans: Copayments

Posted in Health Insurance , Point of Service Plans

September 25th, 2009
No Comments

One of the most comprehensive types of health insurance are provided to members who opt into point of service plans (POS). With a POS plan, policyholders have dozens of choices on how to proceed with their medical care – POS plans offer the flexibility for members to choose their own doctors and encourages them to utilize the managed care network of service providers. If you are a member of a POS plan, the copayment system will work differently depending on whether you choose your own doctor or visit a practitioner that is part of the network.

POS Plan Copayment Structure

The copayment structure for POS plans will vary for members based on the three following criteria:

• Visiting an in-network physician
• Getting an out-of-network referral from your primary care physician (PCP)
• Going to an out-of-network physician without being referred by your primary care physician

With a POS managed care health plan, members are strongly encourage to use the doctors that are under the contractual obligation with the insurance company. By having doctors and hospitals under contract, the insurance company can better control the expenses associated with medical care. The insurance company knows what to expect from the doctors and hospitals under their plan and highly encourage preventive care to lower future costs. Members who opt into using the service network are charged nominal POS copayment amounts in the range of $10-$25 a doctor visit. That money is due upfront will cover any of the necessary tests the doctor orders plus additional medical care.

Out of Network Treatment

When signing up for a POS system, members must choose their primary care physician (the first doctor you’ll see) who is in charge the member’s medical guidance. If a member has a condition that will best be treated by an out-of-network provider, the PCP will refer them. At that point, based on the policy that the member has, it is typical that a deductible amount first needs to be met and then the copayment system will kick in. In this situation, the copayment is a coinsurance arrangement where both the insurance company and the member share the cost of the medical expenses. This type of out of network referral allows the copayment for the POS to be at the highest possible benefit level.

Finally, there are those circumstances where members just choose to see physicians of their choosing without getting a PCP referral. In this case, the copayment for the POS would work similar to above. Since there was no referral from a PCP, the copayment coinsurance rate would be at a “self-referral” benefit rate that would require greater out of pocket contributions from the member towards the medical expenses.

FAQ: How Do POS Plans Work?

Posted in Health Insurance , Point of Service Plans

September 24th, 2009
No Comments

Consumers seeking a type of medical insurance that offers both a level of flexibility and the affordability of a service network of providers should look no further than a point of service plan (POS).POS plans are often considered a hybrid of an HMO and a PPO. By choosing a POS plan, you will be entitled not only to affordable, preventative health care through a service network of providers, you are also purchasing theflexibility to go out of network for medical attention. POS plans operate on two levels, one providing the structure of a service network provider, and the other offering the freedom of a traditional health insurance plan.

In Network

The first level of a POS managed care plan provides members with pre-structured network of physicians and hospitals to choose from. To encourage members to utilize the service network providers, insurance companies make this portion of the health insurance plan extremely affordable. Here are some aspects of this type of policy you should be aware of:

• Members must choose a primary care physician
• Members will have to pay low or nominal copayment amounts for doctors appoints
• There will be extremely low deductibles to be made under this plan, or none at all
• A POS plan will have a selection ofphysicians, hospitals, and other medical providers in place from which members can choose

Out of Network

If you have a POS managed care program, you may also opt to go out of network to get medical care. This portion of the plan is different from the other:

• Members can see any physicians they want with no referral required
• Policyholders will be required to pay for the medical attention they get out of service on their own
• There will be a deductible that will have to be met
• After the deductible is met, coinsurance will kick in where members will be responsible for paying a portion of their medical costs, typically 20-30%
• Members will need to complete their own paperwork in order to submit all their claims to first meet their deductible and then get their partial reimbursement

If you are interested in a POS managed care plan, the providing insurance company should provide you with a complete explanation on how the plan will work.

POS Basic Facts

Posted in Health Insurance , Point of Service Plans

September 23rd, 2009
No Comments

Point of service plans (POS) are a type of managed care health insurance plan. Under a POS plan, members are entitled to affordable health care through a service network of providers and have the flexibility to go out of network. If you are considering different insurance options, there are some things to consider about a POS plan that may help in your decision making process:

• Point of service plans are a managed care plan as they have a contracted network of doctors and physicians that members may choose from in order to get the best cost benefit of the program
• POS plans are affordable but are more expensive than HMOs to offset the unexpected risks associated with out of network health care
• A primary care physician is required for in-network care
• Members can choose to seek medical attention without referrals outside of the service network
• There is typically a deductible that a member must pay before the insurance begins covering the medical care that is out of service
• When the out of service insurance kicks in, it requires a member to pay a portion of the expenses anywhere from 20% to over 30%, thus resulting in a coinsurance payment structure
• If medical attention is sought outside of the service network portion of the plan, the policyholder is required to pay for those expenses out of pocket until they are reimbursed
• Those seeking medical attention outside the POS network will need to complete their own paperwork in order to receive their reimbursement for the expenses
• Because POS plans have both a network of service providers as well as a level of flexibility, they are often considered a hybrid of an HMO and PPO plan

If you are considering joining a POS managed health care plan for your medical insurance, make sure to read all the fine print first to find out what your complete level of financial responsibilities will be for the program.

FAQ: How am I Billed in a POS Plan?

Posted in Health Insurance , Point of Service Plans

September 18th, 2009
No Comments

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.

Costs of POS Plans

Posted in Health Insurance , Point of Service Plans

September 16th, 2009
No Comments

If you hate being limited by “either or” situations, then you may enjoy the flexibility that is standard in a POS (point of service) managed health insurance plan. POS plans allow their members access to a team of skilled physicians at a nominal charge as well as allowing members the flexibility to choose care providers not associated with the POS network. It is a type of hybrid medical insurance plan, and the cost of POS plans vary from provider to provider.

Point of Service Premiums

Like all types of medical insurance, there will be some type of monthly cost associated with a POS plan in the form a premium payment. The cost of a POS plan is considered moderate. Because members must choose their primary physician from within the network, that helps reduce some of the overall costs of the plan. However, since the POS plan grants members the flexibility to choose their own out of network physicians, the POS network cannot control those costs and thus charge more for their premiums to mitigate their expenses.

When a member chooses to seek the medical advice of their primary physician or an in network doctor, the costs are nominal and are in the form of a reasonable co-payment. Because these doctors are in the POS system, the insurance provider can control and better estimate the expenses that may be incurred from general office visits and procedures.

Out of Network Care More Expensive

When a member opts to go out of plan for their medical care, they will pay more. The costs for this portion of a POS plan will be greater for two reasons:

1. Members will typically have to meet a deductible (ranging from approximately $300-$600) before their co-payment will kick in
2. For out of network medical care, the insurance company may only pay from 60%-70% of the services billed, leaving the remainder for the policyholder to pay

Since the price of health care fluctuates from area to area, it is difficult to further isolate the costs of a POS plan. It is important to contact your insurance provider and ask them to provide you with any information they may have so you can properly organize your budget and compare health insurance rates.

Pros and Cons of POS Plans

Posted in Health Insurance , Point of Service Plans

September 14th, 2009
No Comments

A point-of-service plan is a type of managed-care health insurance that furnishes members with a network of doctors and hospitals to visit, as well as providing the flexibility to go out of network when choosing doctors. There are both pros and cons in opting to sign-up for a POS plan that consumers should be aware of before committing to that option.

Having even a minimal level of health insurance is a necessity not only for maintaining your personal well-being but also for warding off a potential financial crisis that can occur due to the out-of-pocket costs for medical care. Making the choice to enroll in a managed-care health insurance plan is a wise decision as the long-term benefits outweigh the overall costs. A POS plan is a type of health insurance policy that may to fulfill all your needs.

Only you can decide what type of health plan is right for you and your family. For instance, if you require more health care than the average person due to preexisting conditions, it may be wise to choose a plan that has lower maximum out-of-pocket expenses. Make sure you do your research and obtain various health insurance quotes before deciding on a plan and provider. By filling out the online Go Insurance Rates health form, you’ll have access to free health rates in a quick and convenient way.

POS Plans for Flexibility

Posted in Health Insurance , Point of Service Plans

August 13th, 2009
No Comments

If you are seeking a type of managed-care health plan that is both flexible and affordable, a “point of service” or POS plan may be your perfect solution. A POS plan is a type of health insurance coverage that provides policy holders with a structured network of doctors, perfect for controlling costs, as well as the flexibility for members to go out of network at will and see whichever doctors they prefer.It is important to realize that the more flexible a health insurance plan, the more costly it will become. POS plans are great for flexibility and are neither the least expensive or most expensive choice for health care.

POS plans are really know for the flexibility they offer their members. Policyholders can seek out medical attention in a number of ways. The POS coverage can be set up to offerfull or partial coverage for non-network providers, plus full coverage for medical care visits to providers within the network. Those options offer policyholders a full range of physicians from which they may choose to seek medical care.

The biggest point contributing to a POS plan’s flexibility is that members can choose from either in-network physicians or may research and choose a doctor on their own. This can be done as long as the initial condition of selecting a primary care physician within the managed-care network.

By choosing a POS plan for the flexibility they offer, you need to consider the additional charges you may accrue for out of network doctors visits. However, if you need the flexibility of a POS plan, the right POS plan may be worth any extra money you may pay.

Advantages and Disadvantages of Managed Care Insurance

Posted in HMO , Health Insurance , Managed Care Insurance , PPO , Point of Service Plans

July 21st, 2009
No Comments

Managed health care is the predominant form of health care in the United States. Those of us who are lucky enough to have health insurance, whether we get it from our employers as a benefit, or if we pay for it out of our own pocket, will more than likely be getting it from a managed health care insurance provider. These providers, whether they are health maintenance organizations (HMOs), preferred provider organizations (PPOs), or point-of-service plans (POS), all come with their various pros and cons. Read on to learn more about the advantages and disadvantages of managed care insurance plans.

One of the advantages to being a member of a managed health care insurance program is the depth and breadth of your choices. If a PPO or HMO system, for example, is large enough, you could have your pick of some very talented doctors and renowned medical facilities. The coverage of your managed care network will be influenced by where you live. Members of a POS or other managed health care systems who live in Atlanta, for example, will be in a bigger network of medical professionals than those living in rural, sparsely populated northern Maine.

Additionally, managed health care insurance organizations create large groups of members, like yourself, which in turn lowers costs for everyone.

In terms of disadvantages, many people in managed care insurance programs complain about their lack of choice – even if they live in a large metropolitan area that has many excellent doctors in it. People who get their health care from managed care insurance programs also don’t like the rigidity of the process, and can easily feel like numbers being pushed through a big, complicated, and unfriendly system – especially if they have a condition which is going to cost the managed care insurance provider a lot of money.

To learn more about the advantages and disadvantages of managed care insurance, be sure to consult with a managed care insurance professional. If you get health insurance from your employer, you can also go over the details of your HMO, PPO, or POS plan with a member of your human resources department.

Are you looking for affordable health insurance quotes? If so, fill our online form and within minutes you’ll receive health insurance rates from leading insurance companies absolutely free. The process is entirely safe and secure.