What is a POS Plan?
he following Questions & Answers are presented only as general information about the plans offered by Piedmont Community Health Plan and Piedmont Community HealthCare. The documents provided to you by your employer, such as Summary Plan Description, Evidence of Coverage, Certificate of Coverage and Schedule of Benefits, will prevail for all benefits, conditions, limitations and exclusions. If your plan requires that you select a primary care physician to coordinate your medical care, then you are covered by a Point of Service plan. Members who are covered by a Preferred Provider Organization plan are not required to select a primary care physician. However, both plans require that members use a physician or other provider who is a member of the Piedmont Community Health Plan network. Additional information is also available from your employer’s human resource department and from Customer Service, Piedmont Community Health Plan at 434-947-4463 or toll-free at 1-800-400-7247.
A POS (Point of Service) plan combines some of the features offered by HMO and PPO plans. As with an HMO, members of a POS plan are required to choose a primary care physician (PCP) from the plan’s network of providers. Services rendered by your PCP are most often not subject to a deductible. Also, like HMOs, POS plans typically offer coverage for preventive care visits. Typically, however, you will only receive a higher level of coverage for services rendered or referred by your PCP. Services rendered by a non-network provider may be subject to a deductible and will likely be covered at a lower level. If services are rendered outside of the network, you’ll likely have to pay up-front and submit a claim to the insurance company yourself.
POS stands for Point of Service. This type of health insurance is a hybrid between a PPO and an HMO. You will still need to have a primary care physician, but you will have access to more health care options within your network. As with an HMO, there are normally no deductibles and co-payments are lower.
POS stands for Point of Service. This type of health insurance is a hybrid between a PPO and an HMO. You will still need to have a primary care physician, but you will have access to more health care options within your network. As with an HMO, there are normally no deductibles and co-payments are lower.
Related Questions
- June 10, 2002 - There is no co-payment required in my Health Net POS plan if I go to an in-network inpatient facility, but CIGNAs is $50 per day. Isn this a reduction in benefit coverage?
- Why are the co-pays higher in the POS plan, while I am already paying a higher premium than similarly situated individuals in the HMO?
- May 2002 - Changing to CIGNAs POS plan will likely increase my out-of-pocket expenses. May I increase (or begin) MERA deductions?
