What is a Point of Service (POS) Plan?

Posted in Health Insurance

February 14th, 2009

POS plans, also known as Point of Service plans, offer the most flexibility available in managed care health insurance. Also known as hybrid health care, they mix aspects of both HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organizations) to create greater patient autonomy.

As with any other health insurance plan, its good to learn the basics before diving in. So here are a few ideas to keep in mind regarding POS plans:

Members dont have to choose an in-network physician. Though the plan will recommend it, members dont have to choose a personal physician from a network of approved providers. So if you have been with a doctor for years and recently switched to a job with POS plans, you wont be required to change.

Members have access to out-of-network providers. While this type of plan requires that members first turn to a network of preferred providers for care, they can also turn to providers outside of the network after receiving referrals. This ensures that patients receive the best health care possible rather than restricting them due to network guidelines. However, members who visit out-of-network specialists without referrals may have to bear the costs associated with the visit on their own.

Patients can visit approved providers within a national network. This is one of the major perks of POS plans. If you are traveling out of town and need to visit a physician, instead of waiting until you get home, you can consult your health insurance company for a list of approved physicians in the area.

POS plans are often highly-revered because they offer more flexibility than HMOs and are considerably cheaper than PPOs. But of course, the type of health insurance you choose is up to you. When deciding, its good to take into consideration the costs (monthly payments, co-pays, deductibles) and benefits associated.