Point-of-Service (POS) Plans

A point of service (POS) plan is very similar to a PPO in the flexibility it affords members. It is also very much like an HMO in that most coverage can be obtained with a small co-pay. So, what exactly is a POS?

A point-of-service plan can be considered a hybrid, a mix between an HMO and a PPO. With a point-of-service plan you choose a primary care physician, who will provide you with the coverage you need or personally refer you to another doctor. The exception to this rule is women in need of gynecological care, who care refer themselves to another physician with no penalty.

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POS Plan Details

The POS is less expensive than a PPO, and allows more freedom than an HMO, which is one of the main advantages of the plan. Although you belong to a network, you do not have to choose an in-network physician. However, if you choose a doctor out of the network you will be footing much of the bill. Another advantage of the POS is that you normally are not required to pay a deductible, so that your money, even from dollar one, goes to your medical coverage.

Your out-of-pocket medical costs are usually limited with a POS plan, which means that no matter how much medical coverage you require, you are guaranteed not to pay out more than a specified amount. For individuals this amounts to around $2,400, while families can spend up to $4,000.

People who benefit most from a POS plan are those who need the freedom to choose different doctors for different members of the family. In an HMO, a family with young children might be forced to leave their pediatrician to sign up with a network provider, in order to receive care, while in a POS, their children can continue to see the same physician (at a higher cost if he/she is not in the network) without being penalized.

The term Point-of-Service is appropriate for this type of insurance coverage. For each doctor's visit or medical emergency, you pay a set fee or co-insurance. You are not paying for future coverage, as you would with a deductible. Rather, you are paying for the services you receive, as you receive them.

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