What Does POS Mean in Health Insurance?

A Point of Service (POS) plan is a managed health care plan available in the United States. Others include the Health Maintenance Organization (HMO) and Preferred Provider Organization (POS) plans. The POS plan is considered a hybrid, as it has characteristics from both HMO and PPO plans that provide members with more options and control over their medical decisions.

Provider Network

• Every POS member is given a provider network, which is a list of physicians contracted to provide medical services in their geographical area. Physicians within the network, in exchange for more patients, have agreed to lower their rates, which benefits the insurance companies and helps keep health care costs low. Insurers are able to provide higher benefits to POS members as a result, which lowers their out-of-pocket expenses.

Primary Care Physician

• Some POS plans require their members to pick a primary care physician (PCP) from their provider network. A PCP is a doctor who is in charge of the patient's medical services. The PCP acts as a "gatekeeper," referring you to other doctors and specialists, while denying certain medical treatments that are deemed are unnecessary. Generally, if you receive medical services from a specialist or another doctor without a referral from your PCP, you are responsible for the entire medical bill. However, the flexibility of POS plans allows members who have PCPs to bypass getting referrals and still receive insurance benefits, explains the American Heart Association.

Fact

• POS plans are not as popular as the other managed health care plans in the United States. The Managed Care National Statistics website states that, according to the Kaiser Family Foundation, only 8.87 million people were covered under a POS plan in 2010. By contrast, HMO and PPO plans covered 66.21 and 53.20 million people during that same year, respectively.

Considerations

• A POS member has two options when deciding where to receive medical attention. When POS members stay in the network for health care, they usually have to satisfy a small co-pay but no deductible, similar to HMO members. If you decide to go out of the network for health services, then you will pay substantial out-of-pocket expenses, like PPO members. According to AgencyInfo.net, POS members can be responsible for up to 40 percent of their non-network medical bill.

Out-of-Pocket/Deductible Amounts

• POS plans typically limit the amount that their members pay out-of-pocket annually. According to AgencyInfo in 2010, that amount is around $2,400 for individuals and $4,000 for families. This includes the yearly deductible amount for non-network care, which costs about $300 for individuals and $600 for families.