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POS Health Insurance Definition

A POS (Point of Service) health insurance plan is one of the big three managed-care plans along with PPO (Preferred Provider Organizations) and HMO (Health Maintenance Organizations). A POS attempts to strike a balance in flexibility and cost between the other forms of health insurance.

  1. The Facts

    • The POS plan aims to combine the flexibility of the PPO with the low cost of the HMO. Like an HMO plan, this type of service relies heavily on preventive care, such as making timely doctor visits to minimize the risk of serious illness or injury. Like a PPO plan, it gives the insured a choice of providers and the freedom to seek services from any doctor without prior approval.

    Pros

    • POS plans tend to be cheaper than PPOs. You have more choice in selecting your primary care physician than in an HBO. Doctors in a POS manage costs by referring patients to other providers within the network. The POS will cover much of the cost of of an out-of-network provider so long as your doctor makes the referrral. The POS is a popular option for business with branch offices because, unlike many HMOs, it covers care in multiple regions.

    Cons

    • POS members have fewer options than those of a PPO. Your primary physician must be within the POS network. If you receive care from an out-of-network specialist, you are responsible for submitting all the paperwork to the insurer.

    Warning

    • If you obtain out-of-network treatment without being referred by your physicians, you will likely incur most or all of the charges. A POS member must satisfy a deductible, which is applied to out-of- network visits without a referral, along with higher co-pays and coinsurance. In some cases, you may have to pay the entire balance and then submit a claim to your insurer for reimbursement.

    Misconceptions

    • Although highly recommended, you don't have to select a PCP (Primary Care Physician) under a POS plan. However, the insurer offers incentives to select an in-network PCP. Members are charged a lower co-pay and/or face a lower deductible if they use an in-network PCP.

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