Point of Service Plan
A point of service (POS) plan implements certain characteristics of a health maintenance organization (HMO) and a preferred provider organization (PPO). POS plans generally fall between the two, offering greater flexibility than HMO plans but less than PPO options.
What is a POS plan?
POS plans are a kind of managed care health insurance option with links to both HMOs and PPOs in the way they are organized. A POS plan involves a group of providers who agree to take care of patients on the plan, thereby seeking to reduce health care costs. You will be asked to select a primary care doctor from a list of those in the scheme, and through this physician you receive your medical care. Like with an HMO, this doctor usually refers you to other professionals within the POS network (but sometimes outside) if you require specialist attention. In this way the primary doctor becomes your ‘point of service,’ as your health care is always directed through them.
Freedom and limits of choice
The networks typically encompass broad geographic areas and a wide base of doctors and facilities. However, your primary care physician might refer you to an out-of-network specialist in idiosyncratic cases, or when certain treatments are not offered within the network. The POS insurance provider should still pay a portion of these fees, but the portion may be lower and it is your responsibility to do the paperwork yourself, submitting claims back to the insurer. If you do not obtain a referral to an outside doctor from your primary physician, and decide to go with an out-of-network doctor regardless, the insurer is likely to pay far less.
Comparison to HMOs
These options guarantee much greater freedom than HMOs, but at a higher financial cost. The premiums for POS insurance are higher, and a yearly ‘deductible’ is payable as always (the amount you need to pay each year before the company pays anything). A similarity between the plans is their focus on preventative health care and education programs, as this helps the companies to save money. Many HMOs actually offer a POS option, so be sure to research any potential insurer.
Comparison to PPOs
POS plans are seen as a sort of bridge between HMOs and PPOs. While PPO plans allow the patient the least restrictive health care in the US, POS plans do not provide the same level of benefits to their customers. This does not mean that freedom is restricted in principle, as both PPO and POS plans allow patients to visit any doctor. But the POS benefits for visiting out-of-network doctors are intended for rare use, in cases where no alternative is available, while PPO patients are expected to use doctors outside the network quite often. These differences are reflected in the prices, as PPO plans are the most expensive.