A POS (Point Of Service Plan) health plan stands for “point of service” and is a mix between an HMO and a PPO-style health insurance policy. With a POS health plan, you have more choices than with an HMO. You may need to select a primary care provider and need a referral to see a specialist. But with a POS plan you have the choice to use doctors, hospitals, and other providers that are not in your health plan’s network. However, you will have to pay more for using out-of-network providers.
A point of service plan, is a type of managed care health insurance plan in the United States. It combines characteristics of the health maintenance organization (HMO) and the preferred provider organization(PPO). The POS is based on a managed care foundation—lower medical costs in exchange for more limited choice. But POS health insurance does differ from other managed care plans. Enrollees in a POS plan are required to choose a primary care physician from within the health care network; this PCP becomes their “point of service”.
The PCP may make referrals outside the network, but with lesser compensation offered by the patient’s health insurance company. For medical visits within the health care network, paperwork is usually completed for the patient. If the patient chooses to go outside the network, it is the patient’s responsibility to fill out forms, send bills in for payment, and keep an accurate account of health care receipts. POS plans combine elements of both HMO and PPO plans.
Like an HMO plan, you may be required to designate a primary care physician who will then make referrals to network specialists when needed. Depending upon the plan, services rendered by your PCP are typically not subject to a deductible and preventive care benefits are usually included. Like a PPO plan, you may receive care from non-network providers but with greater out-of-pocket costs. You may also be responsible for co-payments, coinsurance and an annual deductible.