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Point of Service Insurance Definition

Millions of people are covered by Point of Service (POS) health insurance, which is one of three managed health care plans in the United States. POS plans provide members with flexible health care options at affordable costs. This type of insurance coverage can be obtained through employer-sponsored plans or bought directly from insurance companies as privately owned policies.

  1. About POS Plans

    • POS plans covered almost nine million people in the U.S. in 2010, according to the Kaiser Family Foundation. These plans are considered hybrid coverages as they are combinations of the other two managed health care plans which are PPO (Preferred Provider Organization) and HMO (Health Maintenance Organization). Like HMO members, POS members who use their provider networks pay no deductibles and little to no co-pay amounts. However, they are able to go out of network for health care services like PPO plan members and still receive insurance coverage.

    Provider Network

    • Members of POS plans are provided with networks of doctors in their geographical areas. These doctors perform medical services at discounted rates in exchange for more patients. To help members take advantage of these rates, insurers provide higher insurance benefits for members who stay in-network for care. Members pay little to no deductibles and small co-payments as a result.

    Primary Care Physician

    • According to the American Heart Association, some POS plans encourage, not require, members to choose Primary Care Physicians (PCPs) from their provider networks. PCPs are doctors who are given authority to coordinate their patients' medical care. They are able to refer their patients to doctors and specialists in and out of network for care that is needed. They also have the ability to deny medical services they determine unnecessary or costly. However, by getting referrals, POS members will pay lower out-of-pocket costs when seeking non-network care.

    Warning

    • When POS members go out of network, they are responsible for more of their medical costs out of pocket. In fact, members are liable to be responsible for up to 40 percent. Individuals will also pay deductibles for non-network care as well, averaging about $300 for individuals and $600 for family coverage. Also, if POS members decide to forgo getting referrals from their PCPs, they could be responsible for the entire medical bill without insurance coverage.

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