POS (Point of Service)
POS is a managed care plan that combines the lower cost of HMO with the freedom of choice of a PPO. It is often referred to as an HMO with a point-of-service option.
Access to health care providers: Like an HMO, you are required to choose your primary care physician from within the health care network.
Your primary care physician becomes your "point of service" and will monitor your health care as well as give you referrals to other providers within the network.
Your primary care physician may also make referrals outside the network.
In this case, the POS plan will only pay a portion of the bill and your share of the costs will be higher than if you stayed within the network.
Services: Like HMOs, POS provides you a wide variety of health care services. It covers preventive care, check-ups and tests, as well as inpatient and outpatient hospital care and services.
Costs: Your actual costs includes a monthly premium, which is typically lower than a PPO, and a co-payment for covered medical services accessed
from within the network. You do not need to fill out claim forms for in-network services.
If you use out-of-network providers, you will have a deductible, and a higher coinsurance rate applies after you have met your deductible amount. You will be responsible for filling out the forms, sending the bills to the insurance company for payment, and for keeping health care receipts.
Advantages: POS allows you to choose where you get your care. You can choose providers within the health care network or outside. Costs are lower and level of coverage is higher with in-network services.
Disadvantages: You need to get referrals from your primary care provider to seek treatment from specialists. You pay deductibles and higher coinsurance rates with out-of-network providers.
POS might be a good option for you if you like the freedom offered by a PPO and the lower cost of an HMO.
Remember: The range of covered medical services and benefits varies widely among different health care plans. It is important to read each policy carefully to make sure that the plan covers what is important to you.