Point of Service (POS) Plans

This type of health plan is a hybrid of HMO and PPO elements, bringing together managed care and a moderate amount of flexibility.  POS plans resemble HMOs in that they require members to designate a primary care physician for care coordination who is part of your plan’s network. Thus, the primary care doctor becomes their “point of service,” in order to receive care. However, unlike HMO plans, you have no requirement to stay in-network for all of your services. Like a PPO, members of a point-of-service plan can choose to use out-of-network providers if they prefer to use a certain doctor over one from their plan’s network. Referrals are required from your doctor in order to seek services from a non-network provider.

POS plans are developed around the idea of basic managed care, which is essentially a lower cost of medical care for fewer options. By establishing one primary care doctor and needing referrals, it is a more efficient and cost-effective way to receive care. If you prefer to save money, and get connected to a health plan with a large enough network, POS plans are a great choice.

POS Positives and Negatives

There are several benefits of using in-network care, including that no claims or paperwork are required for medical visits. Network providers will also be available for copay office visits and free preventive care, as well as less expensive out-of-pocket costs. When patients use non-network providers, it is their responsibility to fill out claims, send bills for payment to all parties, and maintain accurate records of medical transactions.

Though structured like an HMO, there is a slight amount of coverage and permission to leave your POS plan’s network for care. Despite your freedom in the ability to use out-of-network care, your plan covers much less when you do decide to go to a non-network provider. For specialist care, you can see non-network providers after receiving a referral from your PCP. Some plans do not require referrals, however, and you may not need to consult with your doctor before using an out-of-network specialist.

Depending on the state and region, different health insurance carriers will offer the POS. Coventry offers a solid amount of POS plans, and they are most frequently found in individual health insurance rather than group. This type of plan is often slightly less expensive than a PPO plan, though it varies based on your area and demographic. To find out if any companies offer POS plans in your city, get a quote.