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What Is Point of Service Plan (POS) – Health Insurance

The Point of Service Plan (POS) attempts to combine the freedom of a PPO with the lower cost of an HMO. POS plans are more flexible than HMOs, but they also require you to select a primary care physician (PCP) to monitor your health care.

The primary POS physician may then make referrals outside the network, but then only some compensation will be offered. For medical visits within the health care network, paperwork is completed for you. If you choose to go outside the network, it is your responsibility to fill out the forms, send bills in for payment.

Advantages Of Point of Service Plan (POS)

  • You may choose to visit a doctor outside the network and still receive coverage but the amount covered will be substantially less than. You have maximum freedom.
  • You are not limited to only HMO network providers.
  • For network care, co-payments are low & there is no deductible.
  • These plans tend to offer more preventive care such as workshops on major problems and discounts to health clubs.

Disadvantages Of Point of Service Plan (POS)

  • You must choose a PCP.
  • Co-payments for non-network care are high.
  • While you may choose to see a physician outside the network, if you don’t receive permission from your PCP, you’re likely to end up submitting the bills yourself and receiving only a nominal reimbursement.

Cost Of Point of Service Plan (POS)

The cost under a POS plan is similar to that of other managed care plans. 
It may be slightly less costly than a PPO because the health insurance company will still regulate most of your health care.

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