POS Basic Facts

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.