A point of service, or POS, plan functions like a cross between a health maintenance organization (HMO) plans and a preferred provider organization (PPO) plan.
Like an HMO…
As with an HMO, you will choose a primary care physician within the POS network. If you seek specialized treatment, you must first obtain a network referral from your primary care physician. Your costs are generally limited to small co-payments.
POS plans tend to focus on preventative care and encourage their members to seek treatment early and sometimes offer benefits such as discounted fitness club memberships or health education classes. There is also a minimal amount of paperwork required for network care.
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Like a PPO…
The POS functions similarly to a PPO when seeking out-of-network coverage. You’ll be required to meet a certain deductible (the average is approximately $300 per individual and approximately $600 per family) and then pay a portion of the physician’s charges as a co-payment.
A POS plan will appeal to a person seeking maximum health care freedom. Although you are strongly encouraged and given significant financial advantages to use network providers, you are not required to do so. You may consult out-of-network specialists without first obtaining a referral. When you do stay within the network, co-payments tend to be minimal and there are no deductibles. If your primary care physician refers you to an out-of-network specialist, the bill may be covered by your insurance company.
When you self-refer outside the network, you will pay the price for your freedom of choice: your co-payments will be much higher and you must meet a deductible before being reimbursed for non-network treatment.
POS plans, like PPO plans, also limit reimbursement of out-of-network care to an amount they determine to be “usual, customary, and reasonable” for the service rendered. Should your chosen healthcare provider charge more than the POS’s pre-determined limit for a service, you will be responsible for making up the difference in cost. You may also have to fill out a considerable amount of paperwork in order to be reimbursed.
Is a POS the best type of managed healthcare system for you?
If you are in good general health and do not have a long-standing relationship with a particular out-of-network physician, an HMO or PPO may be a better and more cost-effective option. However, if flexibility and self-referrals are important to you, the POS plan may be ideal.
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