Pro & Cons of POS Insurance

To manage health care expenses, managed care health plans offer incentives for its members to obtain services in its network. There is usually no reimbursement for out of network services except in emergency situations. Point of service health plans operate along the same lines but do offer coverage for out of network care.

Freedom

• A significant advantage of obtaining a POS health plan is that it gives you the flexibility to receive medical care from any provider. Often referred to as a hybrid health management plan, POS plans combine features of health management organization plans with features of indemnity plans. Like an HMO plan, POS plans offer a network of providers; however, as with indemnity plans, you are free to see any provider you wish. You, therefore, have an extensive list of providers from which to receive your medical care, including in-network and out-of-network providers.

Centralized Care

• Like HMO plans, a primary care physician directs the medical care of POS plan members; however, this service is not mandatory and you may choose to self-direct your health care. POS plans use the primary care physician as the central location for your medical care in hopes of creating a more efficient and effective delivery of health care services, thereby reducing costs. Your primary care physician can help you sift through medical care options, and when the need arises, your primary care physician refers you to a specialist in the POS network.

Cost

• You will likely place cost on both the pro and the con side of the equation. Because in-network providers are contracted by the POS plan, the plan can offer health care services at cost-effective rates. POS plans have built-in financial incentives for you to see in-network providers because the plan cannot control the costs of non-contracted providers. When you see a provider in the POS network, your out-of-pocket costs are significantly lower than when you receive care out of network. For example, you will not pay deductibles, and you will have low co-payments, if any. Conversely, if you choose an out-of-network provider, you incur deductible amounts and your co-payments will be higher, usually a percentage of your provider's charges.

Benefits

• POS plans also focus heavily on preventative and wellness care, and some plans even offer discounts to fitness facilities and nutrition and weight management programs. POS plans encourage members to obtain annual checkups, immunize children and participate in health education seminars, and the plans typically pay for the cost of these services, which can be minimal when compared with managing the cost of catastrophic illnesses that require long-term treatment or inpatient hospital stays. Avoidance of and early detection of illnesses, including catastrophic diseases, is your reward for preventative and wellness care.