| Definition: | A point of service plan, or POS plan, is a health services delivery organization that offers the option to its members to choose to receive a service from participating or a nonparticipating provider. It is a type of managed care health insurance system. It combines characteristics of both the HMO and the PPO. | | | POS plans are sometimes called an ‘open ended HMO’ or an ‘open ended PPO,’ because a point of service plan offers an approved network of medical care facilities and physicians for their policy holder’s to choose from just like HMOs and PPOs. Members of a POS plan do not make a choice about which system to use until the point at which the service is being used. | | | | Overview: | | The level of coverage is generally reduced for services associated with the use of non-participating providers. Subscribers can usually select between different delivery systems (i.e., HMO, PPO, and fee-for-service) when in need of health care services and at the time of accessing the services, rather than making the selection between delivery systems at time of open enrollment at place of employment. | | | | Costs associated with receiving care from the "in network" or approved providers are less than when care is rendered by non-contracting providers or the costs are less if provided by approved providers in either the HMO or PPO rather than "out of network" or "out of plan" providers. Therefore, it specifies that those patients who go outside of the plan for services may pay more out of pocket expenses. This is a method of influencing patients to use certain providers without greatly restricting their freedom of choice. | | | | Differences from HMO & PPO: | A major difference separating POS plans from HMOs and PPOs is that they allow for their policy holder’s to receive medical care outside of the network, though use of facilities and physicians within the network is encouraged. Medical costs may be offered at a lower cost in exchange for limited choices in medical care facilities and physicians, POS plans have several variances from similar plan types. | | | | An example of this is that newly enrolled policy holders of a POS plan are required to choose a primary care doctor to monitor their health. This doctor becomes the new policy holder’s point of service and is chosen from the list of pre-approved doctors in the provider’s approved medical care network. | | | | Referrals: | The POS doctor may refer the policy holder to doctors not included in the network. Although, the claim will not be covered in its entirety as it would have been had procedures and appointments been performed by a health care facility within the approved network. | | | | Policy holders are encouraged to choose facilities and physicians from within the approved network. As a courtesy in many plans, paper work for doctor visits within the network are completed for the policy holder. For medical care visits outside of the network, paper work is expected to be completed by the policy holder. Complete documentation of bills, prescriptions, and receipts are required. | | | | Choosing a POS Plan: | It is best for those interested in the savings associated with low cost combined with limited choices, but travel often and regularly enough to require health care outside of a provider network. | | | | | | Related Links: | | Point of Service Health Plans | | Point of Service (POS) Plan Reference Guide | | Wikipedia: Point of Service Plan |
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