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A Point of Service (POS) health plan is a hybrid of HMO and PPO plans, offering more flexibility than an HMO but with lower out-of-pocket costs than a PPO. Patients are encouraged to choose a personal physician from a network of approved providers, and referrals are required for out-of-network specialists. Emergency care is covered regardless of the network. When selecting a managed care plan, it’s important to consider health, cost, and benefits, and to check the list of approved providers.
A Point of Service (POS) health plan is a type of managed health insurance plan. It offers some flexibility that health maintenance organizations (HMOs) don’t offer. This type of health plan is sometimes referred to as hybrid health care, because it mixes aspects of HMO and Preferred Provider Organization (PPO) for greater patient autonomy.
Like all managed care plans, a POS health plan is designed to provide efficient and effective patient service at the lowest possible cost. Utilizes a network of preferred providers that patients should go to first, receiving referrals to other providers as deemed necessary. Managed care ensures that patients get the medical care they need, as long as they follow the system dictated by the insurance company.
While not required, POS health plans recommend choosing a personal physician from a network of approved providers. The patient sees the personal doctor for all the medical needs of him. In case of special needs, the personal doctor is authorized to refer to another doctor, who may be located within or outside the network of the health insurance company. Patients without a personal doctor may not be covered if they visit specialists. Patients who bypass their personal doctors to go directly to a specialist may be forced to bear the costs themselves.
Most insurance companies have a nationwide network of approved providers, who provide health coverage throughout the United States. When patients need medical treatment while traveling, they can consult their health insurance company for a list of local licensed doctors. In emergency situations, patients should go to the nearest emergency room, regardless of the health coverage network.
A POS health plan offers more flexibility than an HMO, which requires patients to see only doctors in the network, starting with a personal doctor. Visits to out-of-network doctors will not be covered, unless there are special circumstances. Patients have fewer options in an HMO, although the plan may be cheaper, because the restrictive network allows the health insurance company to offer competitive rates.
This type of health plan also differs from a PPO. In a PPO plan, patients can use doctors within a network of affiliated doctors. Patients are not required to see a personal physician, but the trade-off means much higher out-of-pocket costs than with an HMO. Copays tend to be substantially higher even with a PPO than with a POS health plan.
When selecting a managed care plan, there are a number of things to consider. Your health, the cost of the plan, and your benefits are all important things to consider when looking into health care options. If you’re considering a health plan that relies on a network of doctors and hospitals for care, you may want to check the list of approved providers before committing to see if they’ll meet your needs. Your personal physician can often help you select the best insurance plan for you and your family.
