What is a Point of Service (POS) plan?
Under a Point of Service plan, participants can choose a Primary Care Physician (PCP) to help manage their healthcare. The PCP manages all of your healthcare including referrals to specialists and hospitals, and emergency care if you need it. At any time, day or night, 365 days a year, your PCP assumes the primary responsibility for medical care. Should your PCP be unavailable, he or she will arrange for another participating physician to assume responsibility for your care. If you are treated for medical services from a provider without having gone through your PCP, your claims will be paid at the out-of-network benefit level and your responsibility for the cost associated with those claims will be higher than if you had coordinated your care through your PCP.
A POS plan is a cross between an HMO plan and a PPO plan. Similar to an HMO, it is required to select a primary care physician (PCP) whose services will usually be provided independently of a deductible. POS plans also share the HMOs concentration on preventive medicine. The highest percentage of coverage will almost always be for services rendered or referred by your PCP. As with PPOs, visits to out-of-network providers generally require payment of the deductible and less of the costs will be absorbed by the insurance company. Another consideration is that not only may up-front payment be required, but the out-of-network provider will not submit your claim for reimbursement.
A POS plan is a cross between an HMO plan and a PPO plan. Similar to an HMO, it is required to select a primary care physician (PCP) whose services will usually be provided independently of a deductible. POS plans also share the HMO’s concentration on preventive medicine. The highest percentage of coverage will almost always be for services rendered or referred by your PCP. As with PPOs, visits to out-of-network providers generally require payment of the deductible and less of the costs will be absorbed by the insurance company. Another consideration is that not only may up-front payment be required, but the out-of-network provider will not submit your claim for reimbursement.
