FAQ: How Do POS Plans Work?

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.